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

Dumonceau, Jean-Marc; Costamagna, Guido; Tringali, Andrea; Vahedi, Kouroche; Delhaye, Myriam; Hittelet, Axel; Spera, Gianluca; Giostra, Emiliano; Mutignani, Massimiliano; De Maertelaer, Viviane; Deviëre, Jacques
April 2007
Gut;Apr2007, Vol. 56 Issue 4, p545
Academic Journal
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 alter 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.


Related Articles

  • Shocking the Feet to Treat Planter Fasciitis. Tanner, Suzanne M. // Physician & Sportsmedicine;Nov2003, Vol. 31 Issue 11, p16 

    The article presents comments of the editor of the journal "Best of the Literature" on the treatment of planter fasciitis. The journal presents summaries of sports medicine, related articles culled from more than 30 medical journals. Distance runners who had chronic plantar fasciitis and...

  • Extracorporeal Shock Wave Lithotripsy of Pancreatic Duct Stones. Den Toom, Rene; Nijs, Huub G. T.; Van Blankenstein, Marl; Schrörder, Fritz H.; Jeckey, Johannes; Terpstra, Onno T. // American Journal of Gastroenterology;Aug1991, Vol. 86 Issue 8, p1033 

    Chronic calcifying pancreatitis presents a major clinical problem, often requiring extensive surgery. Extra-corporeal shock wave lithotripsy (ESWL) offers a new therapeutic option. We applied ESWL after endoscopic sphincterotomy of the pancreatic orifice in eight patients with impacted...

  • Do stone size and impaction influence therapeutic approach to proximal ureteral stones? Radulović, Slobodan; Vuksanović, Aleksandra; Milenković-Petronić, Dragica; Vavić, Bozo // Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journ;Feb2009, Vol. 66 Issue 2, p129 

    Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral...

  • Outcomes after clearance of pancreatic stones with or without pancreatic stenting. Sasahira, Naoki; Tada, Minoru; Isayama, Hiroyuki; Hirano, Kenji; Nakai, Yousuke; Yamamoto, Natsuyo; Tsujino, Takeshi; Toda, Nobuo; Komatsu, Yutaka; Yoshida, Haruhiko; Kawabe, Takao; Omata, Masao // Journal of Gastroenterology;Jan2007, Vol. 42 Issue 1, p63 

    Extracorporeal shockwave lithotripsy (ESWL) and endoscopic lithotripsy are useful for the fragmentation and extraction of pancreatic stones. However, pancreatic stones often recur, for which an adequate strategy is needed. Treatment for stricture of the main pancreatic duct (MPD) with a...

  • Expulsive medical therapy enhances post-ESWL outcomes. Guttman, Cheryl // Urology Times;8/1/2005, Vol. 33 Issue 9, p1 

    Presents results of a controlled study undertaken by Italian urologists indicating that expulsive medical therapy is a useful adjunct to extracorporeal shockwave lithotripsy in the treatment of ureteral stones. Number of patients enrolled in the study; Responses of patients receiving ketolorac...

  • In Vitro Biomechanical Evaluation of Single Impulse and Repetitive Mechanical Shockwave Devices Utilized for Spinal Manipulative Therapy. Liebschner, Michael; Chun, Kwonsoo; Kim, Namhoon; Ehni, Bruce // Annals of Biomedical Engineering;Dec2014, Vol. 42 Issue 12, p2524 

    Mechanical shockwave therapy devices have been in clinical use for almost 40 years. While most often used to treat back pain, our understanding of their biomechanical performance is very limited. From biomechanical studies we know that biological tissue is viscoelastic and preferably excited...

  • Feasibility of Totally Tubeless Percutaneous Nephrolithotomy Under the Age of 14 Years: A Randomized Clinical Trial. Aghamir, Seyed Mohamad Kazem; Salavati, Alborz; Aloosh, Mehdi; Farahmand, Hasan; Meysamie, Alipasha; Pourmand, Gholamreza // Journal of Endourology;Jun2012, Vol. 26 Issue 6, p621 

    Objective: To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy (PCNL) in comparison with standard PCNL in the children under the age of 14 years. Patients and methods: Twenty-three patients under the age of 14 with renal stones were enrolled in a prospective...

  • Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis. Zheng, Changjian; Yang, Hongmei; Luo, Jun; Xiong, Bo; Wang, Hongzhi; Jiang, Qing // Urolithiasis;Nov2015, Vol. 43 Issue 6, p549 

    This study is to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment for renal calculi 1-2 cm. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Chinese Biomedical Literature...

  • Adjunctive Medical Therapy with α-Blocker after Extracorporeal Shock Wave Lithotripsy of Renal and Ureteral Stones: A Meta-Analysis. Li, Mingchao; Wang, Zhengyun; Yang, Jun; Guo, Xiaolin; Wang, Tao; Wang, Shaogang; Yin, Chunping; Liu, Jihong; Ye, Zhangqun // PLoS ONE;Apr2015, Vol. 10 Issue 4, p1 

    Background: Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL), the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain...


Read the Article


Sign out of this library

Other Topics