Oral Litholysis in Patients with Chronic Calcific Pancreatitis Unresponsive to or Ineligible for Extracorporeal Shock Wave Lithotripsy and Endoscopic Therapy

Abstract

Background/Aims: Our study aimed to evaluate the effect of oral litholysis in patients with chronic calcific pancreatitis (CCP) unresponsive to or ineligible for extracorporeal shock wave lithotripsy (ESWL) and endoscopic therapy. Methods: Trimethadione, an antiepileptic agent, was administered orally at a dose of 0.6–0.9 g/day to 15 patients with this condition. Treatment outcome was evaluated by assessment of dissolution of the pancreatic stones on plain X-ray films and computed tomography scans of the upper abdomen. Plasma glucose, hemoglobin A1c, and body mass index (BMI) were also monitored throughout the therapy. Results: Litholysis was observed in 13 out of 15 patients (86.7%) and was definite in 10 and partial in 3. Six patients had pancreatitis attacks during the therapy; 5 of whom showed definite litholysis and had only 1 mild attack. Of the 11 patients with normal or impaired glucose tolerance at baseline, none developed diabetes mellitus and all showed litholysis. BMI significantly increased in patients whose pancreatic stones dissolved. There was no vital organ impairment by trimethadione. Conclusion: Oral litholysis using trimethadione may represent a noninvasive and effective complementary treatment in patients with CCP unresponsive to or ineligible for ESWL and endoscopic therapy.

Chemical therapy for chronic pancreatitis: An assumption or an alternative?

“…Clinical studies demonstrated that the TMO treatment was effective in dissolving stones, with litholysis or partial litholysis in approximately 86% patients with CCP. [ 23 , 24 ] Additionally, the treatment was highly suggestive of a favorable effect of oral TMO on pancreatic endocrine function and exocrine function in patients whose pancreatic stones were dissolved.…”

“…Second, if the patients discontinued TMO intake, the pancreatic stones recurred and gradually increased in size and number. [ 24 ] Furthermore, these studies have not been validated and there are no randomized or comparative trials with a large sample size to confirm the efficacy of the proposed treatment.…”

Oral Endothelium Corneum Gigeriae Galli Therapy for Pancreatic Duct Stones: A Prospective Cohort Study

“…Only isolated case reports have described some drugs, such as citrate and trimethadione, to be potentially useful in dissolving PDS. 5 , 6 …”