Extracorporeal Shock Wave Lithotripsy of Pancreatic Stones in Chronic Pancreatitis: Immediate and Medium-Term Results

Costamagna, Guido; Gabbrielli, Armando; Mutignani, Massimiliano; Perri, Vincenzo; Pandolfi, M.; M, Boscaini; Crucitti, F

doi:10.1016/s0022-5347(01)62483-2

Cited by 21 publications

(49 citation statements)

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“…Large calculi need to be fragmented prior to extraction or spontaneous expulsion from the MPD. ESWL is now accepted as the standard of care in the management of large PD calculi not amenable to routine endotherapy [2,36,37,[40][41][42][43][44][45] . ESWL is very effective in fragmenting both radio-opaque and radio-lucent calculi in the MPD.…”

Section: Endotherapy Of Pancreatic Ductal Calculimentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.© 2013 Baishideng. All rights reserved.Key words: Chronic pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatic sphincterotomy; Extracorporeal shockwave lithotripsy; Endosonography Core tip: Chronic pancreatitis is a challenge to the therapeutic endoscopist. A patient with chronic pancreatitis can present with ductal calculi, leaks, pseudocysts, strictures, pancreatic malignancy or a biliary obstruction. Endoscopic therapy offers a high rate of success in properly selected patients. It offers many advantages over surgery, which for a long time was considered the gold standard in the treatment of chronic pancreatitis. This chapter deals with the management of chronic pancreatitis associated strictures, calculi, leaks and pseudocysts. The role of endosonography in management of pseudocysts, cannulation of inaccessible ducts and pain relief has also been discussed.Tandan M, Reddy DN. Endotherapy in chronic pancreatitis.

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Section: Endotherapy Of Pancreatic Ductal Calculimentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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“…ESWL overcomes the problem of the stone size by fragmenting the stones, thus facilitating endoscopic clearance of the duct. ESWL is required in 36−68% of patients and successful rates of stone clearance of the main pancreatic duct ranged from 37% to 100% [115,120,173,[179][180][181][182][183][184][185][186][187]. Use of ultrasound instead of x-rays to locate pancreatic stones is associated with a lower fragmentation rate [188,189].…”

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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“…(9,10) Other studies have reported successful ESWL rates of 75%-100%, with subsequent MPD clearance in 37.5%-100.0%. (11,12) ESWL followed by endotherapy is the accepted initial step for most patients with stones larger than 5 mm in the MPD.…”

Section: Pancreatic Ductal Stonesmentioning

confidence: 99%

Current status of endotherapy for chronic pancreatitis

Kwek

Maydeo²

2014

smedj

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Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis.

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Extracorporeal Shock Wave Lithotripsy of Pancreatic Stones in Chronic Pancreatitis: Immediate and Medium-Term Results

Cited by 21 publications

References 0 publications

Endotherapy in chronic pancreatitis

Endotherapy in chronic pancreatitis

Italian consensus guidelines for chronic pancreatitis

Current status of endotherapy for chronic pancreatitis

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