Pancreatic duct stones in chronic pancreatitis: Criteria for treatment intensity and success

Farnbacher, Michael; Schoen, Christoph; Rabenstein, Thomas; Benninger, J.; Hahn, Eckhart G.; Schneider, H. T.

doi:10.1067/mge.2002.128162

Cited by 51 publications

(63 citation statements)

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“…16 Persistent pain relief was defined as the absence of pain recurrence for >2 years. related to our assumption that ESWL alone would be ineffective to treat pain (removal of stone fragments after ESWL was advocated by all experts in the field except some Japanese authors), 25 and that we would thus observe the natural course of chronic pancreatitis for this group (the 90% value was mainly derived from Talamini et al). 26 Although the observed rates of pain relapse were similar in both groups (38 v 45% at 2 years, p = 0.633), this does not show that both treatments are equivalent, as shown by the large 95% CI for the treatment effect (0.23 to 2.57).…”

Section: Discussionmentioning

confidence: 88%

Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial

Dumonceau

Costamagna

Tringali

et al. 2007

Gut

267

158

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Background: In chronic pancreatitis, obstruction of the main pancreatic duct (MPD) may contribute to the pathogenesis of pain. Pilot studies suggest that extracorporeal shock wave lithotripsy (ESWL) alone relieves pain in calcified chronic pancreatitis. Aim: To compare ESWL alone with ESWL and endoscopic drainage of the MPD for treatment of pain in chronic pancreatitis. Subjects: Patients with uncomplicated painful chronic pancreatitis and calcifications obstructing the MPD. Methods: 55 patients were randomised to ESWL alone (n = 26) or ESWL combined with endoscopy (n = 29). Results: 2 years after trial intervention, 10 (38%) and 13 (45%) patients of the ESWL alone and ESWL combined with endoscopy group, respectively, had presented pain relapse (primary outcome) (OR 0.77; 95% CI 0.23 to 2.57). In both groups, a similar decrease was seen after treatment in the MPD diameter (mean decrease 1.7 mm; 95% CI 0.9 to 2.6; p,0.001), and in the number of pain episodes/year (mean decrease, 3.7; 95% CI 2.6 to 4.9; p,0.001). Treatment costs per patient were three times higher in the ESWL combined with endoscopy group compared with the ESWL alone group (p = 0.001). The median delay between the onset of chronic pancreatitis and persistent pain relief for both groups was 1.1 year (95% CI 0.7 to 1.6), as compared with 4 years (95% CI 3 to 4) for the natural history of chronic pancreatitis in a reference cohort (p,0.001). Conclusions: ESWL is a safe and effective preferred treatment for selected patients with painful calcified chronic pancreatitis. Combining systematic endoscopy with ESWL adds to the cost of patient care, without improving the outcome of pancreatic pain.

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Section: Discussionmentioning

confidence: 88%

Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial

Dumonceau

Costamagna

Tringali

et al. 2007

Gut

267

158

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“…In addition to endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL) is a safe method of fragmenting stones prior to ERCP and should therefore be considered to decrease the number of ERCPs needed for successful stone clearance . Furthermore, increasing evidence demonstrates that ESWL alone may be an effective solitary option in patients with painful CP and pancreatic duct dilatation …”

Section: Resultsmentioning

confidence: 99%

“…56 Extracorporeal shock wave lithotripsy In addition to endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL) is a safe method of fragmenting stones prior to ERCP and should therefore be considered to decrease the number of ERCPs needed for successful stone clearance. 57 Furthermore, increasing evidence demonstrates that ESWL alone may be an effective solitary option in patients with painful CP and pancreatic duct dilatation. [58][59][60] Surgical treatment Classical indications for surgery in CP are stenosis of the common bile duct or the duodenum, vascular obstruction, pseudocysts, the suspicion of neoplasm, and abdominal pain that fails to respond to conservative and endoscopic treatment options.…”

Section: Endoscopymentioning

confidence: 99%

Treatment options in painful chronic pancreatitis: a systematic review

D’Haese

Ceyhan

Demir

et al. 2014

HPB

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First-line medical options include the provision of pain medication, adjunctive agents and pancreatic enzymes, and abstinence from alcohol and tobacco. If medical treatment fails, endoscopic treatment offers pain relief in the majority of patients in the short term. However, current data suggest that surgical treatment seems to be superior to endoscopic intervention because it is significantly more effective and, especially, lasts longer.

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“…Stone extraction can be achieved by various techniques, including balloon sweep, lithotripsy (mechanical, extracorporeal shock wave lithotripsy [ESWL] followed by balloon sweep, or electrohydraulic shock wave lithotripsy), or stone retrieval using a basket [27,28].…”

Section: Removal Of Pancreatic Duct Stonesmentioning

confidence: 99%

Current treatment options for chronic pancreatitis

Aziz¹,

Lehman

2007

Curr Treat Options Gastro

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Chronic pancreatitis (CP) is characterized by progressive and ultimately irreversible pancreatic injury. Alcohol abuse is the most common cause of CP in the Western world. As the pathophysiology of this disorder is better understood, it is probable that the treatment will be more successful. Therapeutic efforts for CP are focused on the treatment of maldigestion, pain, and diabetes. Dosage and timing of enteric-coated pancreatic enzymes are important issues in the treatment of malabsorption due to CP. Non-enteric-coated enzyme preparations along with acid suppression (histamine-2 blockers or proton-pump inhibitors) are of limited to modest effectiveness in treating pain caused by CP but are worth a trial in patients with less advanced disease. Extracorporeal shock wave lithotripsy (ESWL) of calcified stones is sometimes needed to achieve stone fragmentation before endoscopic removal. The role of ESWL alone in relieving calcified CP pain needs further study. Endoscopic therapy is aimed at decompressing the obstructed pancreatic duct and removal of pancreatic stone and is associated with pain relief in many patients. The role of endoscopic ultrasonography-guided celiac plexus block should be limited to treating those patients with CP whose pain has not responded to other modalities. Radiation therapy to the whole pancreas for CP pain relief is a revived treatment option that needs further study to confirm the safety and efficacy. Total pancreatectomy followed by autologous islet cell autotransplantation appears to be a potential therapeutic approach but should be considered as the last option in patients with refractory pain who have failed conventional medical, endoscopic, and surgical options.

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Pancreatic duct stones in chronic pancreatitis: Criteria for treatment intensity and success

Cited by 51 publications

References 0 publications

Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial

Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial

Treatment options in painful chronic pancreatitis: a systematic review

Current treatment options for chronic pancreatitis

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