Abstract
BackgroundAlthough most patients with autoimmune pancreatitis (AIP) respond favorably to prednisolone therapy, some individuals who later suffer from pancreatic calculi may require additional extracorporeal shock wave lithotripsy (ESWL) treatment. This study compares the efficacy of ESWL for calculi in AIP with that in ordinary chronic pancreatitis (CP) and proposes a new treatment approach for pancreatic duct stones occurring in AIP.MethodsWe examined the clinical records of 8 patients with chronic stage AIP and 92 patients with ordinary CP who received ESWL for pancreatic calculi.ResultsThe AIP group was significantly older than the CP group (69.0 vs. 56.5 years, P = 0.018). With regard to the indications for ESWL, chronic pain was significantly less frequent in the chronic stage AIP group (0% vs. 45.7%, P = 0.001), whereas preservation of pancreatic function was significantly more frequent (75% vs. 19.6%, P = 0.001). Compared with the CP group, the AIP group tended to exhibit pancreatic duct stenosis proximal to pancreatic calculi and had a lower rate of complete extraction of stones from the main pancreatic duct. Histopathological analysis of a patient with chronic stage AIP revealed widely distributed nodular pancreatitis, which was characteristic of ordinary CP, along with isolated areas of lymphoplasmacytic sclerosing pancreatitis.ConclusionsDifferent approaches are needed for the treatment of pancreatic calculi in chronic stage AIP and ordinary CP. Specifically, it appears that intensive ESWL therapy can be avoided or delayed in AIP if the patient displays: (1) advanced age, (2) little or no chronic pain or pancreatitis, and (3) pancreatic duct stenosis proximal to pancreatic stones. In such cases, the benefit of ESWL treatment may be outweighed by the risks involved in this procedure.
Highlights
Most patients with autoimmune pancreatitis (AIP) respond favorably to prednisolone therapy, some individuals who later suffer from pancreatic calculi may require additional extracorporeal shock wave lithotripsy (ESWL) treatment
We identified that the major risk factors for AIP developing into chronic pancreatitis (CP) that satisfied the Revised Japanese Clinical Diagnostic Criteria (JCDC) for Ordinary Chronic Pancreatitis [28] were pancreatic head swelling and main pancreatic duct (MPD) non-narrowing in the pancreatic body [29]
Univariate analysis for comparisons between chronic stage AIP and ordinary CP groups revealed that the AIP group was significantly older (69.0 vs. 56.5 years, P = 0.018)
Summary
Most patients with autoimmune pancreatitis (AIP) respond favorably to prednisolone therapy, some individuals who later suffer from pancreatic calculi may require additional extracorporeal shock wave lithotripsy (ESWL) treatment. We identified that the major risk factors for AIP developing into CP that satisfied the Revised Japanese Clinical Diagnostic Criteria (JCDC) for Ordinary Chronic Pancreatitis [28] were pancreatic head swelling and MPD non-narrowing in the pancreatic body [29]. These findings suggested that AIP could progress to confirmed CP with severe pancreatic stone formation over a long-term period, most presumably due to disease recurrence and pancreatic juice stasis from remnant pancreatic duct stenosis [30]
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