Success of extracorporeal shock wave lithotripsy and ERCP in symptomatic pancreatic duct stones: a systematic review and meta-analysis

Abstract

Background and study aims Pain is the most frequent and dominant symptom of chronic pancreatitis. Currently, these patients are treated using a step-up approach, including analgesics and lifestyle adjustments, endoscopic, and eventually surgical treatment. Extracorporeal shock wave lithotripsy (ESWL) is indicated after failure of the first step in patients with symptomatic intraductal stones larger than 5 mm in the head or body of the pancreas. To assess the complete ductal clearance rate and pain relief after ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones, a systematic review and meta-analysis was performed. Patients and methods A systematic literature search from January 2000 to December 2018 was performed in PubMed, the Cochrane Library, and EMBASE for studies on ductal clearance rate of ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones. Results After screening 486 studies, 22 studies with 3868 patients with chronic pancreatitis undergoing ESWL for pancreatic duct stones were included. The pooled proportion of patients with complete ductal clearance was 69.8 % (95 % CI 63.8–75.5). The pooled proportion of complete absence of pain during follow-up was 64.2 % (95 % CI 57.5–70.6). Complete stone fragmentation was 86.3 % (95 % CI 76.0–94.0). Post-procedural pancreatitis and cholangitis occurred in 4.0 % (95 % CI 2.5–5.8) and 0.5 % (95 % CI 0.2–0.9), respectively. Conclusion Treatment with ESWL results in complete ductal clearance rate in a majority of patients, resulting in absence of pain during follow up in over half of patients with symptomatic chronic pancreatitis caused by obstructing pancreatic duct stones.

Long‐term outcome of endotherapy for pancreatic stones by using a dedicated pancreatic basket catheter

“…Acute exacerbation is defined as acute pancreatitis during the follow‐up of chronic pancreatitis. The diagnosis of acute pancreatitis is based on “Japanese Guidelines for the Management of Acute Pancreatitis: Japanese Guidelines 2015.” 20 Complete stone removal was defined as no filling defects in the main PD on pancreatography with or without intraductal ultrasonography according to the previous reports 9,15,21–32 . Complete stone removal of pancreatic stones was additionally confirmed by computed tomography (CT) scan within 3 months after ERCP.…”

Endoscopic retrograde cholangiopancreatography: Current practice and future research

“…Previous studies have shown that adding ESWL significantly decreases pain scores, yearly hospitalizations for pancreatitis, and opioid use[ 98 ]. A systematic review and meta-analyses of 22 ESWL ERCP studies noted high rates of complete stone fragmentation at 86.3% (95%CI: 76.0-94.0)[ 99 ]. The pooled percentage of patients with complete ductal clearance, however was 69.8% (95%CI: 63.8-75.5).…”

Neutrophil Extracellular Trap-Driven Occlusive Diseases

“…The pancreatic duct, also known as the Wirsung duct, connects the pancreas and intestine through the common bile duct. Its primary function is to transport enzymes and bicarbonate, which aid digestion and neutralize the duodenal pH, respectively [ 75 , 76 ]. Occlusion of the pancreatic duct may cause pancreatitis.…”

“…Occlusion of the pancreatic duct may cause pancreatitis. The occlusions of the ducts are directly proportional to the severity of the pancreatitis and depend on the duration of the disease [ 75 , 76 ].…”