Oral Litholysis Therapy for Endoscopically Unretrievable Obstructive Pancreatic Stones

Noda, Aiji; Ibuki, Eri; Izumi, Junko; Hamano, Koh‐ichi; Ota, Masahito; Maekawa, Masato

doi:10.1097/01.mpa.0000160279.18710.f1

Cited by 2 publications

(5 citation statements)

References 8 publications

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“…The prior interventional therapies including endoscopic sphincterotomy and papillary dilatation combined with ESWL may facilitate the effect of OLT on stone elimination [ 7 ]. In this patient, endoscopic sphincterotomy was insufficient, and the papilla of Vater was endoscopically normal (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Overcoming these problems is a primary concern when managing patients with chronic calcific pancreatitis, particularly during the so-called transitional stage. Previously, Noda et al [ 5 – 7 ] developed oral litholysis therapy (OLT) with use of trimethadione (3,5,5-trimethyl-2,4-oxazolidinedione; TMO) for calcified pancreatic stones and have reported its usefulness for chemical dissolution of pancreatic stones. Here, we report a case of chronic calcific pancreatitis, in which both endocrine dysfunction and malnutrition were gradually but definitely improved during OLT.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of oral litholysis therapy for improving glucose intolerance and malnutrition in patients with poor results following endoscopic therapy and extracorporeal shock wave lithotripsy for calcified pancreatic stones

Ashizawa

Hamano

Noda

2015

Clin J Gastroenterol

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We report a case of pancreatolithiasis in which glucose intolerance and malnutrition were significantly improved after starting oral litholysis therapy (OLT) with use of trimethadione. A 43-year-old female with multiple calcified stones in the main and peripheral pancreatic ducts had experienced recurrent and severe attacks of pain for 7 years (from 21 to28 years of age). Impaired glucose tolerance was first noted at the age of 32 years. We started OLT after interventional endoscopic therapy combined with extracorporeal shock wave lithotripsy failed because of kink and stenosis of the main pancreatic duct (MPD). Over the next 9 years, a significant decrease in total pancreatic calcified stone volume was shown by computer analysis of follow-up computed tomography images. Larger stones completely disappeared without attacks of pain. In addition, both glucose intolerance and insulin secretion were significantly ameliorated, followed by improvement of malnutrition. OLT may induce intraductal decompression by dissolving stones in the peripheral ducts as well as the MPD, with resulting preservation of endocrine function and improvement of malnutrition. Since the present results were obtained in a single case, further clinical trials are necessary to evaluate the value of performing OLT under various conditions to eliminate stones.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of oral litholysis therapy for improving glucose intolerance and malnutrition in patients with poor results following endoscopic therapy and extracorporeal shock wave lithotripsy for calcified pancreatic stones

Ashizawa

Hamano

Noda

2015

Clin J Gastroenterol

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“…Endoscopic therapy aims to eliminate as many stones as possible from the ducts and ultimately improves the outflow of pancreatic juice. On the other hand, dimethadione shrinks and disintegrates stones, leading to smooth clearance of stones from the ducts [18,19]. These overlapping mechanisms of action appear to have played roles in the representative cases of patients 1 and 2 who underwent ESWL and endoscopic therapy prior to or during OLT, implying the usefulness of litholytic therapy combined with ESWL and endoscopic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Of these patients who discontinued OLT, 4 showed definite litholysis, 4 showed partial litholysis, and 2 showed no litholysis. The interim progress of 2 patients, who were different from those presented in the previous section, has already been described elsewhere [18,19].…”

Section: Completion and Continuationmentioning

confidence: 99%

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

Hamano

Noda²,

Ibuki³

et al. 2019

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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.

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Oral Litholysis Therapy for Endoscopically Unretrievable Obstructive Pancreatic Stones

Cited by 2 publications

References 8 publications

Effectiveness of oral litholysis therapy for improving glucose intolerance and malnutrition in patients with poor results following endoscopic therapy and extracorporeal shock wave lithotripsy for calcified pancreatic stones

Effectiveness of oral litholysis therapy for improving glucose intolerance and malnutrition in patients with poor results following endoscopic therapy and extracorporeal shock wave lithotripsy for calcified pancreatic stones

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

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