Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis

Abstract

Background: Long-term results of extracorporeal shockwave lithotripsy (ESWL) for large pancreatic duct (PD) stones in patients with idiopathic calcific pancreatitis (CP) are scanty.

Objective: To evaluate intermediate and long-term results of ESWL in a large cohort of patients with idiopathic CP.

Design: Cross-sectional study; retrospective chart review.

Setting: A high-volume, tertiary-care center for endoscopy and GI diseases.

Patients: A total of 636 patients with idiopathic CP who underwent ESWL and ERCP were followed-up. Patients were divided into intermediate (24-60 months) and long-term (>60 months) follow-up groups.

Intervention: ESWL and ERCP.

Main outcome measurements: Improvement in pain, analgesic use, hospitalization for pain, recurrence of calculi, need for additional intervention, and quality of life.

Results: A total of 636 of 1006 patients who underwent ESWL between 2004 and 2009 were followed for a maximum of 96 months. There were 364 patients in the intermediate follow-up group and 272 in the long-term follow-up group. After ESWL and ERCP, absence of pain was seen in 250 patients (68.7%), mild-to-moderate pain in 94 patients (25.4%), and severe pain in 20 patients (5.5%) of the intermediate group. In the long-term group, 164 patients (60.3%) had no pain, 97 patients (35.7%) had mild or moderate episodes of pain, whereas 11 patients (4.04%) had episodic severe pain. Recurrence of calculi was seen in 51 patients (14.01%) in the intermediate follow-up group and in 62 patients (22.8%) in the long-term group. Quality of life improved in a significant number of patients in both groups.

Limitations: Retrospective study, single center, recall bias, and subjective pain and quality-of-life measurement scale.

Conclusion: ESWL for large PD calculi offers good results in patients of idiopathic CP on intermediate and long-term follow-up.

Keywords: CP; ESWL; Hb(A1c); MPD; MRCP; Magnetic resonance cholangiopancreatography; PD; calcific pancreatitis; extracorporeal shockwave lithotripsy; glycosylated hemoglobin; main pancreatic duct; pancreatic duct.