Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy

Abstract

Background-There have been conflicting reports as to whether pancreatic ductal drainage achieved by endoscopy and lithotripsy improves the clinical outcome of patients with chronic pancreatitis. Aims-To determine the clinical outcome in patients with chronic pancreatitis who received extracorporeal shock wave lithotripsy (ESWL), and were followed up for two to eight years. Methods-Eighty patients with severe chronic pancreatitis and endoscopically unretrievable obstructive stones underwent ESWL with a piezoelectric lithotripter between 1989 and 1996. Clinical status, relief of symptoms, further endoscopic or surgical interventions, and mortality were defined. Results-Forty three (54%) patients were treated successfully with ESWL. The only feature associated with treatment success was the presence of a single stone rather than multiple stones. Successfully treated patients tended to experience less pain, although this did not reach statistical significance. A slight increase in weight was noted in our patients; however, there was no notable improvement in anomalous stools and diabetes mellitus. Five patients died due to extrapancreatic reasons. No pancreatic carcinomas developed. Conclusions-ESWL associated with endoscopic drainage is a safe technique that is particularly successful in patients with a single stone. However, pancreatic drainage by endoscopy and ESWL has almost no eVect on pain in chronic pancreatitis. Furthermore, endoscopic management and ESWL does not prevent or postpone the development of glandular insuYciency. (Gut 1999;45:402-405)

Usefulness and safety of Endoscopic Pancreatic Duct Balloon Dilation（EPDBD）for treatment of pancreatic diseases- pancreatic stone, divisum and pseudocyst

“…Excretion rate and symptom disappearance rate results at our hospital were similar but recurrence rate was significantly lower at 5.6%, considered to be an effect of combined EPDBD therapy [13][14][15][16][17][18][19][20][21]. However, some limitation is that the effect is not permanent; negative effects on the pancreatic duct and parenchyma is unknown; not knowing how much air pressure and time is best; and not having specialized tools available [22][23][24][25][26][27][28][29].…”

Italian consensus guidelines for chronic pancreatitis

“…Transabdominal US is able to confirm the diagnosis of advanced chronic pancreatitis, since it identifies the thinning of the pancreatic parenchyma, the irregularity of the pancreatic margins, dilatation of the main pancreatic duct and of the side branches, and endoductal calcified stones [114][115][116]. Transabdominal US is not able to depict early chronic pancreatitis, since it does not recognize parenchymal and ductal changes indicative of the early phase of chronic pancreatitis [114,[117][118][119][120][121][122][123][124][125][126][127].…”

Risk factors for diabetes mellitus in chronic pancreatitis: A cohort of 2,011 patients

“…42 The finding that endoscopic treatment by ERCP/ ESWL was not associated with an increased/decreased risk of DM development is also consistent with previous studies. 43 Interpretation of the identified risk factors is 2-fold. First, DM monitoring (eg, fasting glucose and HbA1c) in high-risk individuals (those with one or more risk factors) should be more frequent than ''average-risk'' individuals (those without identified risk factors).…”