Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts

• Published in: Gastrointestinal endoscopy 2016-07, Vol.84 (1), p.69-78
• Main Authors: Li, Bai-Rong, MD, Liao, Zhuan, MD, Du, Ting-Ting, MD, Ye, Bo, MD, Chen, Hui, MD, Ji, Jun-Tao, MD, Zheng, Zhao-Hong, MD, Hao, Jun-Feng, MD, Ning, Shou-Bin, MD, Wang, Dan, MD, Lin, Jin-Huan, MD, Hu, Liang-Hao, MD, Li, Zhao-Shen, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Calculi - diagnostic imaging; Calculi - etiology; Calculi - therapy; Case-Control Studies; Cholangiopancreatography, Endoscopic Retrograde - methods; Endosonography; Female; Gastroenterology and Hepatology; Hemorrhage - epidemiology; Humans; Lithotripsy; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Diseases - diagnostic imaging; Pancreatic Diseases - etiology; Pancreatic Diseases - therapy; Pancreatic Pseudocyst - diagnostic imaging; Pancreatic Pseudocyst - etiology; Pancreatic Pseudocyst - surgery; Pancreatitis - epidemiology; Pancreatitis, Chronic - complications; Postoperative Complications - epidemiology; Prospective Studies; Surgical Wound Infection - epidemiology; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2015.10.026

Background and Aims We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts (PPCs) in chronic pancreatitis (CP). Methods This is a prospective study performed in CP patients with at least 1 stone (≥5 mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression. Results A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPC group and the control group (11.86% vs 12.41%, P  = .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P  = .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life ( P  < .001), physical health ( P  < .001), and weight loss ( P  < .001) improved. Conclusions In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.