Stones In Chronic Pancreatitis Research Articles

Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study.

Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for pancreatic stones in chronic pancreatitis. In contrast, peroral pancreatoscopy-guided lithotripsy (POPS-L) remains underexplored, with limited comparative studies to ESWL. This study compared the treatment outcomes of disposable POPS-L tools and ESWL for pancreatic stones. A retrospective analysis was conducted on 66 patients who had undergone pancreatic stone treatment at three institutions between 2006 and 2022. The treatment outcomes of POPS-L and ESWL were compared. This study included 19 and 47 patients who had undergone POPS-L and ESWL, respectively. In a comparison between POPS-L and ESWL, the stone clearance rates were 78.9% vs. 70.2% (p = 0.55), while the procedure-related complication rates were 21% vs. 6.3% (p = 0.09). The median total session counts were 1 vs. 5 (p < 0.01). The cumulative stone recurrence rates were comparable in both groups. Multivariate analysis revealed no significant factors influencing the stone clearance rates, and the choice between POPS-L and ESWL did not affect the stone clearance rates. POPS-L and ESWL exhibited comparable treatment outcomes in terms of stone clearance, complications, and recurrence rates. Furthermore, POPS-L is advantageous due to the need for fewer sessions to achieve pancreatic stone clearance.

Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial

Backgrounds/ObjectivesPatients with chronic pancreatitis may develop pancreatic duct stones that can obstruct outflow leading to ductal hypertension and pain. Both endoscopic retrograde pancreatography (ERP) with per-oral pancreatoscopy (POP) and intraductal lithotripsy and extracorporeal shock wave lithotripsy (ESWL) are feasible options to attempt ductal stone clearance. This study aims to compare POP-guided lithotripsy with ESWL in the management of refractory symptomatic main pancreatic duct stones. MethodsThis is an open-label, multi-center, parallel, randomized clinical trial. Patients with chronic pancreatitis and main pancreatic duct stones ≥5 mm who fail standard ERP methods for stone removal will be eligible for this study. In total, 150 subjects will be randomized 1:1 to either ESWL or POP. A maximum of 4 sessions of either ESWL or POP will be allowed in each arm, with crossover permitted thereafter. The primary outcome is complete stone clearance and secondary outcomes include quality of life, pain scores, number of interventions, and daily opiate requirements. ConclusionsThis study aims to answer the question of which lithotripsy method is superior in removing refractory pancreatic duct stones while addressing the effects of lithotripsy on quality of life and pain in patients with chronic calcific pancreatitis (ClinicalTrials.gov NCT04115826).

A randomized-controlled trial of early endotherapy versus wait-and-see policy for mild symptomatic pancreatic stones in chronic pancreatitis.

Although surgical or endoscopic treatment is effective for pain control in symptomatic calcified chronic pancreatitis, it is still unknown whether early intervention in mild symptomatic pancreatic stones would reduce the frequency of acute exacerbation and improve long-term outcomes. The aim of this randomized-controlled trial was to explore the efficacy of early endotherapy for mild symptomatic pancreatic stones in comparison with the wait-and-see policy. Patients with mild symptoms because of pancreatic stones were assigned randomly to the endotherapy or the wait-and-see group. The wait-and-see group received endotherapy only when they developed refractory exacerbation or intractable pain. The primary outcome was the cumulative incidence of intolerable pain attacks and acute exacerbation. The secondary outcomes were the development of pancreatic insufficiency and the progression of pancreatic atrophy. A total of 20 patients were enrolled between March 2008 and March 2011. The study was terminated prematurely because of the poor patient enrollment. Early endotherapy tended to reduce the cumulative incidence of pain attacks and exacerbation, (P=0.17) with the composite incidence of pain attacks and exacerbation of 30% in the endotherapy group and 60% in the wait-and-see group. There were no significant differences in terms of diabetic status and the presence of steatorrhea. The thickness of the pancreas decreased significantly in the wait-and-see group (9.2-6.8 mm, P=0.041), but not in the endotherapy group (8.7-9.0 mm, P=0.60). In a small group of patients, early endotherapy in mild symptomatic chronic pancreatitis was associated with a trend toward a minor number of acute attacks and atrophy progression of the pancreas.

Spatial Distribution of Pancreatic Stones in Chronic Pancreatitis.

The aim of this study was to establish a standard to describe the spatial distribution of pancreatic stones in chronic pancreatitis (CP). Two hundred forty-seven CP patients with pancreatic stones from June to December 2012 were enrolled. Two-dimensional images from coronal projection of 3-dimensional computed tomography images of pancreatic stones were gained. The number (n) of all stones and the geometric standard deviation (σ) of distances between the centroid of all stones and the centroids of every stone that represented the spatial distribution nonuniformity were calculated by Stone Reconstruction and Identification Programming System. The mean value of n and σ were 13.6 and 22.5; n > 13.6 and σ > 22.5 were determined as "multistones" and "nonuniform," respectively. Compared with alcoholic CP, idiopathic CP was less prone to multistones (odds ratio [OR], 0.310) and more prone to nonuniform (OR, 3.247). Pancreatic pseudocyst (OR, 2.211) in CP course was a risk factor of multistones, whereas diabetes mellitus in first-/second-/third-degree relatives (OR, 0.382) was a protective factor. Age at diagnosis of pancreatic stones (OR, 1.022) was a risk factor of nonuniformity. Compared with idiopathic CP, alcoholic CP patients were prone to more pancreatic stones that distribute more uniformly.

Mo1240 - Spatial Distribution of Pancreatic Stones in Chronic Pancreatitis

Mo1240 - Spatial Distribution of Pancreatic Stones in Chronic Pancreatitis

Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: Is it always necessary?

Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: Is it always necessary?

Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy is recommended as treatment for stones in chronic pancreatitis. The aim of this study was to investigate the risk factors for complications of pancreatic extracorporeal shock wave lithotripsy (P-ESWL). Patients with painful chronic pancreatitis and pancreatic stones (> 5 mm diameter) who were treated with P-ESWL between March 2011 and June 2013 were prospectively included. Adverse events after P-ESWL were classified as complications and transient adverse events, depending on severity. The major complications of P-ESWL included post-ESWL pancreatitis, bleeding, infection, steinstrasse, and perforation. Multivariate analyses based on univariate analysis were performed to detect risk factors of overall and moderate-to-severe complications. A total of 634 patients underwent 1470 P-ESWL procedures. The overall complication rate was 6.7 % of all procedures. Complications occurred in 62 patients (9.8 %) after the first ESWL procedure. The risk factors for complications were pancreas divisum (odds ratio [OR] 1.28) and the interval between diagnosis of chronic pancreatitis and P-ESWL (OR 1.28). Protective factors were male sex (OR 0.50), diabetes (OR 0.45), and steatorrhea (OR 0.43). Male sex, the only identified predictor for moderate-to-severe complications, was a protective factor (OR 0.19). For the second P-ESWL procedure, complications occurred in 22/409 patients (5.4 %). Complication and asymptomatic hyperamylasemia after the first ESWL session were significantly associated with higher risk for complications after the second ESWL session (P < 0.05). Patient-related factors were important in determining a high risk of P-ESWL complications when no procedure-related factors were identified. Patients suffering from complications after the first ESWL session were also likely to experience complications in subsequent P-ESWL sessions.

Recent advances in pancreatology.

Recent advances in pancreatology.

Endoscopic Versus Surgical Treatment of Downstream Pancreatic Duct Stones in Chronic Pancreatitis

Pancreatic duct stone is thought not only to be the cause of abdominal pain but also to be a risk factor for pancreatic cancer. Several treatment options have been implemented in the treatment of pancreatic duct stones. Stone location is a critical factor in selecting treatment. We present the results of 27 endoscopic treatments and 35 surgical treatments performed in three hospitals at a single university between January 2000 and January 2005. The results were compared retrospectively in terms of success rate of stone removal, length of hospital stay, complications, pain relief, and changes of pancreatic functions. In our study, endoscopy resulted in a similar success rate of stone removal and short-term pain relief rate as the surgical approach and with a shorter length of hospital stay. However, the surgical group had a more favorable long-term clinical result, as well as a lower number of hospital readmissions at the 5-year follow-up point. Based on long-term results, surgical treatment is more effective than endoscopy.

Extracorporeal Shockwave Lithotripsy (ESWL) for Treatment of Pancreatic Stones in Chronic Pancreatitis

Extracorporeal Shockwave Lithotripsy (ESWL) for Treatment of Pancreatic Stones in Chronic Pancreatitis

Utility of Peroral Cholangioscope (Spy Glass System) in Treatment of Stones in Chronic Pancreatitis

Chronic pancreatitis is a difficult clinical condition to treat. Stones in the main pancreatic duct could lead to increased ductal pressure and cause pain, inflammation and other complications. Endoscopic therapy is aimed at reduction of the pressure in the main pancreatic duct. Endoscopic armamentarium is limited. Extracorporeal shock wave lithotripsy though useful is available only at a very few centers in the United States. Mechanical lithotripsy is difficult and is associated with significant complications including the inability to crush the stones, broken and captured baskets. Electro hydraulic lithotripsy (EHL) would be beneficial but could not be used earlier because of the limitation of direct visualization of the stones in the main pancreatic duct. Recently a single operator duodenoscope assisted cholagiopancreatoscopy (Spy glass system, Boston Scientific, MA) was introduced. This was primarily developed for evaluation and treatment of biliary tract disease. Aim: To evaluate the feasibility and efficacy of electrohydraulic lithotripsy of main pancreatic duct stones in chronic pancreatitis using Spy glass system. Methods: Retrospective analysis of the data of pancreatoscopies done using Spy glass. Results: Between July 07 and November 07, 16 procedures were performed with Spy glass system. 8 patients had chronic pancreatitis. Of these 8, 2 underwent cholangioscopy for evaluation of the bile duct and 6 underwent pancreatoscopy. Main pancreatic duct calcifications were seen in 5 patients and EHL was performed. In 4 of the 5 patients stones could be fragmented by EHL and subsequently stones were removed by stone/basket. All the stones could not be removed and 2 of these patients had subsequent pancreatoscopies with removal of more stone material. In one case EHL was attempted but was unsuccessful because of difficult angulation and inability to achieve adequate contact between the probe and the stone. No procedure related complications were seen. Conclusions: 1. Spy glass system allows for direct visualization of the stones in the main pancreatic duct and EHL could be safely performed to decompress the main pancreatic duct. This adds to the current armamentarium of the endoscopic accessories for therapy of pancreatic stones. 2. Limitations include use in non dilated/strictured ducts because of the current size of the catheter (7Fr) and maneuverability within the duct. 3. Currently used EHL probes are designed for urological procedures and hence the length of the probe is a limitation, moreover the probe is not rigid and can kink easily. Specially designed probes are in development and might solve this problem.

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

Background: The aim of the study was to evaluate interventional endoscopic management of pancreatic duct stones in patients with chronic pancreatitis by describing therapeutic methods and defining factors that predict technical success. Methods: Records were retrospectively analyzed for 125 patients with symptoms caused by chronic pancreatitis with pancreatic duct stones (single 43, multiple 82) treated by interventional endoscopy, including extracorporeal shockwave lithotripsy. Results: Technical success was achieved in 85% of patients (11 patients by mechanical lithotripsy, 114 by piezoelectric extracorporeal shockwave lithotripsy). There were no serious complications from lithotripsy. Univariate analysis disclosed a statistically significant association between treatment success and patient age as well as prepapillary location of stones. A greater therapeutic effort was necessary in patients with stones located in the tail of the pancreas, 2 or more stones, a stone 12 mm or more in diameter, or who have had a longer duration (>8 years) of the disease. However, with exception of the last parameter, correction for multiple testing of data removed statistical significance. Conclusions: Extracorporeal shockwave lithotripsy enhances endoscopic measures for treatment of pancreatic duct stones when mechanical lithotripsy fails. Middle-aged patients in the early stages of chronic pancreatitis with stones in a prepapillary location proved to be the best candidates for successful treatment. Unfavorable patient-related or morphologic factors can be compensated for through more intense efforts at therapy. (Gastrointest Endosc 2002;56:501-6.)

Extracorporeal Shock Wave Lithotripsy of Pancreatic Stones in Chronic Pancreatitis

Extracorporeal Shock Wave Lithotripsy of Pancreatic Stones in Chronic Pancreatitis

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

Abstract Background: Obstruction of the main pancreatic duct with upstream hypertension and dilation is a cause of pain in patients with chronic pancreatitis. Pancreatic ductal drainage can be achieved endoscopically by intraductal stone removal after endoscopic pancreatic sphincterotomy and/or by insertion of a pancreatic stent. Extracorporeal shock wave lithotripsy may be needed whenever stones cannot be removed by endoscopic procedures. We present our results in 35 patients treated with a combined endoscopic-extracorporeal shock wave lithotripsy approach with at least 6 months of follow-up. Methods: Thirty-five patients with severe chronic pancreatitis were treated by extracorporeal shock wave lithotripsy for endoscopically unretrievable obstructive stones. Extracorporeal shock wave lithotripsy was performed with an electromagnetic lithotriptor in 29 patients and an electrohydraulic lithotriptor in 6. Results: The procedures were well tolerated by the majority of patients. Fragmentation of stones was obtained in all cases while complete clearance and decompression of pancreatic duct were obtained in 26 of 35 (74.3%) and in 30 of 35 (85.7%) cases, respectively. There was no mortality related to the procedure. Morbidity was observed in 8 of 35 patients (22.8%). Conclusions: Extracorporeal shock wave lithotripsy is a safe and effective treatment for endoscopically unretrievable pancreatic stones in the main pancreatic duct. Extracorporeal shock wave lithotripsy should be considered complementary and not an alternative to endoscopic drainage. Combined with endoscopy, extracorporeal shock wave lithotripsy may increase the success rate of nonsurgical treatment of patients with chronic pancreatitis.(Gastrointest Endosc 1997;46:231-6.)

Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results

Background: Obstruction of the main pancreatic duct with upstream hypertension and dilation is a cause of pain in patients with chronic pancreatitis. Pancreatic ductal drainage can be achieved endoscopically by intraductal stone removal after endoscopic pancreatic sphincterotomy and/or by insertion of a pancreatic stent. Extracorporeal shock wave lithotripsy may be needed whenever stones cannot be removed by endoscopic procedures. We present our results in 35 patients treated with a combined endoscopic-extracorporeal shock wave lithotripsy approach with at least 6 months of follow-up. Methods: Thirty-five patients with severe chronic pancreatitis were treated by extracorporeal shock wave lithotripsy for endoscopically unretrievable obstructive stones. Extracorporeal shock wave lithotripsy was performed with an electromagnetic lithotriptor in 29 patients and an electrohydraulic lithotriptor in 6. Results: The procedures were well tolerated by the majority of patients. Fragmentation of stones was obtained in all cases while complete clearance and decompression of pancreatic duct were obtained in 26 of 35 (74.3%) and in 30 of 35 (85.7%) cases, respectively. There was no mortality related to the procedure. Morbidity was observed in 8 of 35 patients (22.8%). Conclusions: Extracorporeal shock wave lithotripsy is a safe and effective treatment for endoscopically unretrievable pancreatic stones in the main pancreatic duct. Extracorporeal shock wave lithotripsy should be considered complementary and not an alternative to endoscopic drainage. Combined with endoscopy, extracorporeal shock wave lithotripsy may increase the success rate of nonsurgical treatment of patients with chronic pancreatitis.(Gastrointest Endosc 1997;46:231-6.)

Oral citrate in chronic pancreatitis

To assess the efficacy of oral citrate administration in dissolving intraductal stones in chronic pancreatitis, a controlled clinical trial vs placebo was carried out on a group of selected patients with advanced chronic calcified pancreatitis. Twenty-two cases were assigned to placebo for 18 mo, and then to citrate for a further 18 mo (20 g/d) (Schedule A); another 22 cases were randomly assigned to citrate (40 g/d) for 18 mo and then followed but not treated for a further 18 mo (Schedule B). Prior to entry and at the end of each 18 mo interval, clinical and lab data were collected and evaluated, and pancreatic calcifications were assessed. Whereas when the patients were on placebo a trend towards an increase in the number of calcifications was observed, at the end of the citrate treatments, one in four to one in five patients showed some reduction in radiologic calcification (p<0.05). Citrate was reasonably tolerated, and no relevant side effects were observed during and after its administration. Even if with the higher dose of citrate an increased number of patients underwent clinical remission, no clear relationship was found between the treatment being investigated and the clinical course of the disease. This investigation shows that oral citrate is capable of favoring some reduction of stones in patients with chronic calcified pancreatitis.