Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1171-1322
Success of extracorporeal shock wave lithotripsy and ERCP in symptomatic pancreatic duct stones: a systematic review and meta-analysis
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202008/lookinside/thumbnails/1800_10-1055-a-1171-1322-1.jpg)
Abstract
Background and study aims Pain is the most frequent and dominant symptom of chronic pancreatitis. Currently, these patients are treated using a step-up approach, including analgesics and lifestyle adjustments, endoscopic, and eventually surgical treatment. Extracorporeal shock wave lithotripsy (ESWL) is indicated after failure of the first step in patients with symptomatic intraductal stones larger than 5 mm in the head or body of the pancreas. To assess the complete ductal clearance rate and pain relief after ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones, a systematic review and meta-analysis was performed.
Patients and methods A systematic literature search from January 2000 to December 2018 was performed in PubMed, the Cochrane Library, and EMBASE for studies on ductal clearance rate of ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones.
Results After screening 486 studies, 22 studies with 3868 patients with chronic pancreatitis undergoing ESWL for pancreatic duct stones were included. The pooled proportion of patients with complete ductal clearance was 69.8 % (95 % CI 63.8–75.5). The pooled proportion of complete absence of pain during follow-up was 64.2 % (95 % CI 57.5–70.6). Complete stone fragmentation was 86.3 % (95 % CI 76.0–94.0). Post-procedural pancreatitis and cholangitis occurred in 4.0 % (95 % CI 2.5–5.8) and 0.5 % (95 % CI 0.2–0.9), respectively.
Conclusion Treatment with ESWL results in complete ductal clearance rate in a majority of patients, resulting in absence of pain during follow up in over half of patients with symptomatic chronic pancreatitis caused by obstructing pancreatic duct stones.
Publication History
Received: 19 December 2019
Accepted: 30 March 2020
Article published online:
21 July 2020
© 2020. Owner and Copyright ©
© Georg Thieme Verlag KG
Stuttgart · New York
-
References
- 1 Yadav D, Timmons L, Benson JT. et al. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol 2011; 106: 2192-2199
- 2 Frulloni L, Gabbrielli A, Pezzilli R. et al. Chronic pancreatitis: report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis 2009; 41: 311-317
- 3 Schneider A, Lohr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 2007; 42: 101-119
- 4 Mullady DK, Yadav D, Amann ST. et al. Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Gut 2011; 60: 77-84
- 5 White TT, Bourde J. A new observation on human intraductal pancreatic pressure. Surg Gynecol Obstet 1970; 130: 275-278
- 6 Drewes AM, Krarup AL, Detlefsen S. et al. Pain in chronic pancreatitis: the role of neuropathic pain mechanisms. Gut 2008; 57: 1616-1627
- 7 Drewes AM, Bouwense SAW, Campbell CM. et al. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology 2017; 17: 720-731
- 8 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018. Endoscopy 2019; 51: 179-193
- 9 Lohr JM, Dominguez-Munoz E, Rosendahl J. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J 2017; 5: 153-199
- 10 Moole H, Jaeger A, Bechtold ML. et al. Success of Extracorporeal shock wave lithotripsy in chronic calcific pancreatitis management: a meta-analysis and systematic review. Pancreas 2016; 45: 651-658
- 11 Dumonceau JM, Costamagna G, Tringali A. et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut 2007; 56: 545-552
- 12 Wells GASB, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000 Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
- 13 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 2003; 327: 557-560
- 14 Korpela T, Udd M, Tenca A. et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol 2016; 51: 866-871
- 15 Rubenstein JN, Parsons WG, Kim SC. et al. Extracorporeal shock wave lithotripsy of pancreatic duct stones using the Healthtronics LithoTron lithotriptor and the Dornier HM3 lithotripsy machine. J Urol 2002; 167: 485-487
- 16 Wang D, Ji JT, Xin L. et al. Extracorporeal shock wave lithotripsy for chronic pancreatitis patients with stones after pancreatic surgery. Pancreas 2018; 47: 609-616
- 17 Tandan M, Reddy DN, Talukdar R. et al. Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis. Gastrointest Endosc 2013; 78: 726-733
- 18 Kozarek RA, Brandabur JJ, Ball TJ. et al. Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2002; 56: 496-500
- 19 Hu LH, Ye B, Yang YG. et al. Extracorporeal shock wave lithotripsy for chinese patients with pancreatic stones: a prospective study of 214 cases. Pancreas 2016; 45: 298-305
- 20 Li BR, Liao Z, Du TT. et al. Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts. Gastrointest Endosc 2016; 84: 69-78
- 21 Ohyama H, Mikata R, Ishihara T. et al. Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones. Pancreas 2015; 44: 422-428
- 22 Tadenuma H, Ishihara T, Yamaguchi T. et al. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol 2005; 3: 1128-1135
- 23 Milovic V, Wehrmann T, Dietrich CF. et al. Extracorporeal shock wave lithotripsy with a transportable mini-lithotripter and subsequent endoscopic treatment improves clinical outcome in obstructive calcific chronic pancreatitis. Gastrointest Endosc 2011; 74: 1294-1299
- 24 Brand B, Kahl M, Sidhu S. et al. Prospective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis. Am J Gastroenterol 2000; 95: 3428-3438
- 25 Delhaye M, Arvanitakis M, Verset G. et al. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol 2004; 2: 1096-1106
- 26 Karasawa Y, Kawa S, Aoki Y. et al. Extracorporeal shock wave lithotripsy of pancreatic duct stones and patient factors related to stone disintegration. J Gastroenterol 2002; 37: 369-375
- 27 Farnbacher MJ, Schoen C, Rabenstein T. et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success. Gastrointest Endosc 2002; 56: 501-506
- 28 Inui K, Tazuma S, Yamaguchi T. et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas 2005; 30: 26-30
- 29 Suzuki Y, Sugiyama M, Inui K. et al. Management for pancreatolithiasis: a Japanese multicenter study. Pancreas 2013; 42: 584-588
- 30 Ito K, Igarashi Y, Okano N. et al. Efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy, and additional electrohydraulic lithotripsy using the SpyGlass direct visualization system or X-ray guided EHL as needed, for pancreatic lithiasis. Biomed Res Int 2014; 2014: 732781
- 31 Lapp RT, Wolf Jr. JS. et al. Duct diameter and size of stones predict successful extracorporeal shock wave lithotripsy and endoscopic clearance in patients with chronic pancreatitis and pancreaticolithiasis. Pancreas 2016; 45: 1208-1211
- 32 Parsi MA, Stevens T, Lopez R. et al. Extracorporeal shock wave lithotripsy for prevention of recurrent pancreatitis caused by obstructive pancreatic stones. Pancreas 2010; 39: 153-155
- 33 Merrill JT, Mullady DK, Early DS. et al. Timing of endoscopy after extracorporeal shock wave lithotripsy for chronic pancreatitis. Pancreas 2011; 40: 1087-1090
- 34 Maruyama M, Watanabe T, Kanai K. et al. Extracorporeal shock wave lithotripsy treatment of pancreatic stones complicated with advanced stage autoimmune pancreatitis. BMC Gastroenterol 2015; 15: 28
- 35 Vaysse T, Boytchev I, Antoni G. et al. Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis. Scand J Gastroenterol 2016; 51: 1380-1385
- 36 Sherman S, Lehman GA, Hawes RH. et al. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc 1991; 37: 511-517
- 37 Delhaye M, Vandermeeren A, Baize M. et al. Extracorporeal shock-wave lithotripsy of pancreatic calculi. Gastroenterology 1992; 102: 610-620
- 38 Inui K, Masamune A, Igarashi Y. et al. Management of pancreatolithiasis: a nationwide survey in Japan. Pancreas 2018; 47: 708-714
- 39 Crossley GH, Poole JE, Rozner MA. et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management: executive summary this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm 2011; 8: e1-e18
- 40 Nguyen-Tang T, Dumonceau JM. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol 2010; 24: 281-298
- 41 Tandan M, Reddy DN, Santosh D. et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience. Indian J Gastroenterol 2010; 29: 143-148
- 42 Adamek HE, Jakobs R, Buttmann A. et al. Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy. Gut 1999; 45: 402-405
- 43 Dumonceau JM, Deviere J, Le Moine O. et al. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results. Gastrointest Endosc 1996; 43: 547-555
- 44 Choi EK, McHenry L, Watkins JL. et al. Use of intravenous secretin during extracorporeal shock wave lithotripsy to facilitate endoscopic clearance of pancreatic duct stones. Pancreatology 2012; 12: 272-275
- 45 Beyna T, Neuhaus H, Gerges C. Endoscopic treatment of pancreatic duct stones under direct vision: Revolution or resignation? Systematic review. Dig Endosc 2018; 30: 29-37
- 46 Lamme B, Boermeester MA, Straatsburg IH. et al. Early versus late surgical drainage for obstructive pancreatitis in an experimental model. Br J Surg 2007; 94: 849-854
- 47 Dite P, Ruzicka M, Zboril V. et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 2003; 35: 553-558
- 48 Cahen DL, Gouma DJ, Nio Y. et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356: 676-684
- 49 Drewes AM, Kempeneers MA, Andersen DK. et al. Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons!. Gut 2019; DOI: 10.1136/gutjnl-2019-318742.
- 50 Issa Y, Kempeneers MA, Bruno MJ. et al. Effect of early surgery vs endoscopy-first approach on pain in patients with chronic pancreatitis: the ESCAPE randomized clinical trial. JAMA 2020; 323: 237-247