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Liu Y, Yi JH, Wang PY, Fu P, Kang Y, Wang T, Zhang D, Zhang XH, Xu JJ, Zhang SL, Han PD, Wang F, Zhou XY, Feng JS, Xu JJ, Qian JH, Wang D, Chen H, Liu RH, Wang FY, Li ZS, Hu LH. Safety evaluation of extracorporeal shockwave lithotripsy for pancreatic stones: Experience based on a large chronic pancreatitis cohort. Dig Liver Dis 2024:S1590-8658(24)00962-9. [PMID: 39261265 DOI: 10.1016/j.dld.2024.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/01/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The safety of extracorporeal shock wave lithotripsy for pancreatic stones (P-ESWL) and adverse events were not evaluated and classified within large sample population. This study aimed to evaluate the safety and classify the adverse events of P-ESWL based on a large sample cohort. METHODS This is an observational study based on the large prospective chronic pancreatitis (CP) cohort. Patients with painful pancreatic stones over 5 mm who underwent P-ESWL between March 2011 and June 2018 at Shanghai Changhai Hospital were included. Adverse events after P-ESWL including complications and transient adverse events (TAEs) were recorded. Risk factors of adverse events were analyzed through univariable and multivariable logistics regression analysis. Sensitivity analysis was conducted to test the stability of the study. RESULTS Totally 2,071 patients underwent 5,002 sessions of P-ESWL were included. The overall complication rate and TAEs rate after all P-ESWL procedures were 5.2% and 20.9%. The complications and TAEs rate decreased obviously within the first 6 sessions. Several independent risk factors for adverse events after P-ESWL were identified. Sensitivity analysis suggested the stability of the results. CONCLUSIONS P-ESWL is a safe treatment for pancreatic stones. Multiple P-ESWL sessions did not increase the complications and TAEs rate. ClincialTrials.gov number, NCT05916547.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, Jiangsu, China; Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China; Department of Pharmacology, College of Pharmacy, Naval Medical University, Shanghai, 200433, China
| | - Jin-Hui Yi
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Peng-Yuan Wang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China; Department of Gastroenterology, the 981st Hospital of PLA, Chengde, 067000, Hebei, China
| | - Peng Fu
- Department of Pharmacy, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Ying Kang
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, Jiangsu, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Di Zhang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Xi-Hong Zhang
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, 250012, Shandong, China; Department of Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Jin-Jie Xu
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Song-Lin Zhang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Pei-Dong Han
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Fan Wang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Xiao-Yu Zhou
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Jia-Sheng Feng
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Jia-Jun Xu
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Jia-Hao Qian
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Hui Chen
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China
| | - Run-Hui Liu
- Department of Pharmacology, College of Pharmacy, Naval Medical University, Shanghai, 200433, China.
| | - Fang-Yu Wang
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, Jiangsu, China.
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China.
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China.
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Liu Y, Yin XY, Cui JH, Wang T, Feng XY, Yi JH, Xu JJ, Zhang SL, Han PD, Wang D, Liu RH, Wang FY, Li ZS, Hu LH. Long-term clinical outcomes of extracorporeal shockwave lithotripsy and endoscopic retrograde cholangiopancreatography for pancreatic duct stone treatment in patients with chronic pancreatitis. Aliment Pharmacol Ther 2024. [PMID: 39169663 DOI: 10.1111/apt.18224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/28/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND AND AIMS Extracorporeal shock wave lithotripsy for pancreatic stones (P-ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferred therapeutic approaches for painful chronic pancreatitis (CP) with pancreatic stones. This study aimed to report the short- and long-term outcomes following P-ESWL and ERCP in a large cohort with CP. METHODS Patients with painful CP and pancreatic stones >5 mm in size, who underwent P-ESWL and subsequent ERCP between March 2011 and June 2018, were included in this retrospective-prospective mixed observational study. The total stone clearance rates were recorded. All patients were followed up until the end of March 2024, with the visual analogue scale (VAS) for pain, pain type, quality-of-life scores and other relevant information recorded. RESULTS A total of 2071 patients underwent P-ESWL, and 93.1% of them subsequently underwent ERCP during the study period. Patients were followed up for an average of 11.8 years from the onset of CP and 6.7 years from the first P-ESWL procedure. Complete stone clearance was achieved in 73.7% of the patients. At the end of the follow-up period, 70.1% of the patients achieved complete pain remission. Significant pain type conversion and lower VAS scores were observed in the patients after treatment. Quality-of-life scores and body mass indices increased after P-ESWL and ERCP. CONCLUSIONS P-ESWL and ERCP are effective and minimally invasive treatments for pancreatic stones in patients with painful CP. Most patients achieved complete pain relief, and pain-type conversion was common after treatment. (ClinicalTrials.gov: NCT05916547).
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
- Department of Pharmacology, College of Pharmacy, Naval Medical University, Shanghai, China
| | - Xiao-Yi Yin
- Department of Hepatobiliary Pancreatic Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia-Hui Cui
- Department of Pharmacy, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Xiao-Yue Feng
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Gastroenterology and Hepatology, Jinling Clinical College of Nanjing Medical University, Jinling Hospital, Nanjing, Jiangsu, China
| | - Jin-Hui Yi
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Jin-Jie Xu
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Song-Ling Zhang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Pei-Dong Han
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Run-Hui Liu
- Department of Pharmacology, College of Pharmacy, Naval Medical University, Shanghai, China
| | - Fang-Yu Wang
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Gastroenterology and Hepatology, Jinling Clinical College of Nanjing Medical University, Jinling Hospital, Nanjing, Jiangsu, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China
- National key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
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Tandan M, Pal P, Jagtap N, Reddy DN. Endoscopic interventions in pancreatic strictures and stones-A structured approach. Indian J Gastroenterol 2024:10.1007/s12664-024-01644-9. [PMID: 39145851 DOI: 10.1007/s12664-024-01644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/25/2024] [Indexed: 08/16/2024]
Abstract
Chronic pancreatitis (CP) is an irreversible disease of varied etiology characterized by destruction of pancreatic tissue and loss of both exocrine and endocrine function. Pain is the dominant and most common presenting symptom. The common cause for pain in CP is ductal hypertension due to obstruction of the flow of pancreatic juice in the main pancreatic duct either due to stones or stricture or a combination of both. With advances in technology and techniques, endoscopic retrograde cholangiography (ERCP) and stenting should be the first line of therapy for strictures of the main pancreatic duct (MPD). Small calculi in the MPD can be extracted by ERCP and balloon trawl. Extracorporeal shockwave lithotripsy (ESWL) remains the standard of care for large pancreatic calculi and aims to fragment the stones 3 mm or less that can easily be extracted by a subsequent ERCP. Single operator pancreatoscopy with intraductal lithotripsy is a technique in evolution and can be tried when ESWL is not available or is unsuccessful in producing stone fragmentation.
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Affiliation(s)
- Manu Tandan
- Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, 6-3-661, Hyderabad, 500 082, India.
| | - Partha Pal
- Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, 6-3-661, Hyderabad, 500 082, India
| | - Nitin Jagtap
- Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, 6-3-661, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, 6-3-661, Hyderabad, 500 082, India
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Kawka M, Lucas A, Riad AM, Hawkins D, de Madaria E, West H, Jakaityte I, Lee MJ, Kouli O, Ruanne R, Gujjuri RR, Brown S, Cambridge WA, Pandanaboyana S, Kamarajah SK, McLean KA. Quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach. HPB (Oxford) 2024; 26:859-872. [PMID: 38735815 DOI: 10.1016/j.hpb.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Pancreatitis is a common surgical emergency, associated with pain and poor quality of life for patients. However, assessment of patient-reported outcome measures in these patients is unclear. This study aimed to identify and evaluate the methodological quality of the health-related quality of life instruments used for patients with acute or chronic pancreatitis. METHODS Prospective studies that evaluated health-related quality of life in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 28th June 2023 (PROSPERO: CRD42021274743). Instrument characteristics were extracted, and methodological quality assessed using COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) guidelines and GRADE approach. Narrative synthesis was conducted, with recommendations for use based on COSMIN criteria, evaluated according to World Health Organisation (WHO) quality of life domains. RESULTS From 3850 records screened, 41 quality of life instruments were identified across 138 studies included. The majority (69.8%, n = 26) were designed to assess general health-related quality of life, whereas the remainder were abdominal-specific (n = 5) or pancreas-specific (n = 10). Only ten instruments (24.3%) demonstrated sufficient content validity, incorporating items in ≥5 WHO quality of life domains. However, only nine instruments (21.9%) incorporated public and patient involvement. Only the Gastrointestinal Quality of Life Index and PAN-PROMISE met the criteria to be recommended for use based on COSMIN methodological assessment. CONCLUSION There is significant heterogeneity in instruments used to assess quality of life after pancreatitis, with almost all instruments considered insufficient. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve quality of life for these patients.
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Bush N, Chandragiri P, Gaurav NA, Sonaiya S, Lahooti I, Singh A, Gupta A, Afghani E, Papachristou G, Khashab MA, Lee PJ, Talukdar R, Lakhtakia S, Singh VK, Han S, Tandan M, Akshintala VS. Development of a novel CT-based index for predicting the number of extracorporeal shockwave lithotripsy (ESWL) sessions required for successful fragmentation of obstructing pancreatic duct stones. Pancreatology 2024; 24:643-648. [PMID: 38584052 DOI: 10.1016/j.pan.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND & AIM Extracorporeal shock wave lithotripsy (ESWL) is used for the treatment of pancreatic duct stones (PDS) in patients with chronic pancreatitis (CP). We aimed to develop a CT based index to predict the required number of ESWL sessions for technical success. METHODS We retrospectively evaluated patients with PDS secondary to CP who underwent ESWL. Technical success was defined as the complete fragmentation of stones to <3 mm. CT features including PDS size, number, location, and density in Hounsfield units (HU) were noted. We analyzed the relationship between PDS characteristics and the number of ESWL sessions required for technical success. A multiple linear regression model was used to combine size and density into the pancreatic duct stone (PDS) index that was translated into a web-based calculator. RESULTS There were 206 subjects (mean age 38.6 ± 13.7 years, 59.2% male) who underwent ESWL. PDS size showed a moderate correlation with the number of ESWL sessions (r = 0.42, p < 0.01). PDS in the head required a fewer number of sessions in comparison to those in the body (1.4 ± 0.6 vs. 1.6 ± 0.7, p = 0.01). There was a strong correlation between PDS density and the number of ESWL sessions (r = 0.617, p-value <0.01). The PDS index {0.3793 + [0.0009755 x PDS density (HU)] + [0.02549 x PDS size (mm)]} could accurately predict the required number of ESWL sessions with an AUC of 0.872 (p < 0.01). CONCLUSION The PDS index is a useful predictor of the number of ESWL sessions needed for technical success that can help in planning and patient counseling.
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Affiliation(s)
- Nikhil Bush
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Praneeth Chandragiri
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitish Ashok Gaurav
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sneh Sonaiya
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ila Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anmol Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Abhinav Gupta
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elham Afghani
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Georgios Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mouen A Khashab
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rupjyoti Talukdar
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Manu Tandan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Venkata S Akshintala
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Han C, Lv YW, Hu LH. Management of chronic pancreatitis: recent advances and future prospects. Therap Adv Gastroenterol 2024; 17:17562848241234480. [PMID: 38406795 PMCID: PMC10894541 DOI: 10.1177/17562848241234480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
As a progressive fibroinflammatory disease, chronic pancreatitis (CP) often manifests as recurrent bouts of abdominal pain with or without complications, causing a heavy burden of health care. In recent years, some meaningful insights into the management of CP have been obtained from randomized controlled trials, systematic reviews, and meta-analyses, which were of great importance. Based on this research, it is shown that there are various treatments for CP. Therefore, it is of great importance to choose a suitable strategy for patients with CP individually. Relevant evidence on the management of CP was summarized in this review, including nutrition supplements, medication, endoscopy, surgery, exploration of novel therapies as well as evaluation and prediction of treatment response.
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Affiliation(s)
- Chao Han
- Department of Gastroenterology, The Hospital of 91876 Troops of Chinese People’s Liberation Army, Qinhuangdao, China
| | - Yan-Wei Lv
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai 200433, China
- National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China
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Yi JH, Li ZS, Hu LH. Adverse events of pancreatic extracorporeal shock wave lithotripsy: a literature review. BMC Gastroenterol 2023; 23:360. [PMID: 37853330 PMCID: PMC10585860 DOI: 10.1186/s12876-023-02992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
Pancreatic stones are the result of pathophysiologic changes in chronic pancreatitis with an incidence of more than 90%. At present, pancreatic extracorporeal shock wave lithotripsy (P-ESWL) can be used as the first-line treatment for large or complex stones. Although a large number of studies have proven the safety and effectiveness of P-ESWL, we should also pay attention to postoperative adverse events, mainly due to the scattering of shock waves in the conduction pathway. Adverse events can be classified as either complications or transient adverse events according to the severity. Because the anatomic location of organs along the shock wave conducting pathway differs greatly, adverse events after P-ESWL are varied and difficult to predict. This paper outlines the mechanism, definition, classification, management and risk factors for adverse events related to P-ESWL. It also discusses the technique of P-ESWL, indications and contraindications of P-ESWL, and adverse events in special populations.
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Affiliation(s)
- Jin-Hui Yi
- Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
| | - Liang-Hao Hu
- Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
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Pancreatic Stones and Extracorporeal Shockwave Lithotripsy: A Review of the Literature. Pancreas 2022; 51:916-922. [PMID: 36607935 DOI: 10.1097/mpa.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT Pancreatic stones are sequelae of chronic pancreatitis, resulting in poor quality of life, frequent hospitalizations, and a significant economic burden. Extracorporeal shock wave lithotripsy (ESWL) can be used to treat pancreatic stones and is less invasive when compared to other modalities. In this review article, we have discussed the role of ESWL in the treatment of pancreatic stones and how it differs from other modalities. Databases were searched electronically for articles discussing the treatment of pancreatic ductal stones by ESWL or other modalities. Articles discussing or comparing treatment success rates were preferentially included. An inductive approach was used to identify articles related to the treatment of pancreatic stones with ESWL throughout the review process. Although laser lithotripsy and electrohydraulic lithotripsy appear to have higher success rates, the potential for ESWL to affect clinical outcomes is substantial, especially in individuals with a higher risk for invasive procedures. The decision to perform ESWL should be considered if the outcome will substantially alter the clinical management when performed by an experienced endoscopist. Further randomized controlled trials are needed to compare ESWL and peroral pancreatic lithotripsy methods.
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Wang D, Xu J, Bi YW, Mei CL, Li ZS, Hu LH. Pancreatic extracorporeal shock wave lithotripsy for a patient concurrent with autosomal dominant polycystic kidney disease: a case report. J Int Med Res 2022; 50:3000605221100748. [PMID: 35634907 PMCID: PMC9158420 DOI: 10.1177/03000605221100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Whether pancreatic extracorporeal shock wave lithotripsy (ESWL) is safe for patients with autosomal dominant polycystic kidney disease (ADPKD) is unclear. A woman in her early 30s was admitted to our hospital because of intermittent upper abdominal pain and recurrent pancreatitis. The imaging results confirmed the diagnosis of pancreatic stones and ADPKD. We performed pancreatic ESWL using a third-generation lithotripter to pulverize the pancreatic stones. A maximum of 5000 shock waves was delivered per therapeutic session. A second session of ESWL was performed the next day. The patient developed no adverse events or complications related to pancreatic ESWL. Three years after treatment, the patient had developed no relapse of pancreatitis or abdominal pain. Shock waves do not lead to complications such as hematuria, cyst rupture, or deterioration of the inner bleeding of renal cysts. Multiple kidney cysts are not a contraindication for pancreatic ESWL.
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Affiliation(s)
- Dan Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jing Xu
- Department of Nephrology, Kidney Institute of Chinese PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ya-Wei Bi
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Chang-Lin Mei
- Department of Nephrology, Kidney Institute of Chinese PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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10
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Liu Y, Yin XY, Wang D, Dong ZQ, Hao L, Chen C, Wang T, Zhang D, Ma JY, Yang HY, Li J, Zhang LL, Bi YW, Zhang Y, Xin L, Chen H, Zhang QS, Xie T, Lu GT, Li ZS, Liao Z, Hu LH. Risk factor analysis and nomogram development for steatorrhea in idiopathic chronic pancreatitis. J Dig Dis 2022; 23:331-340. [PMID: 35703114 DOI: 10.1111/1751-2980.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Steatorrhea, a sign of severe pancreatic exocrine insufficiency (PEI), is related to consequences caused by pancreatitis. This study aimed to identify predictors and to construct a nomogram for steatorrhea in idiopathic chronic pancreatitis (ICP). METHODS ICP patients admitted to our hospital from January 2000 to December 2013 were enrolled in this retrospective-prospective cohort study and randomly assigned to the training and validation cohorts. The cumulative rate of steatorrhea was calculated. A Cox proportional hazard regression model was used to identify predictors for steatorrhea and construct the nomogram. Internal and external validation of the nomogram was then performed. RESULTS There were 1633 ICP patients enrolled, with a median follow-up duration of 9.8 years and 20.8% (339/1633) of patients developed steatorrhea following onset of ICP. Steatorrhea was observed in 93, 115, and 133 patients at 1, 3, and 5 years following diagnosis of CP, with a cumulative rate of 6.5% (95% confidence interval [CI] 5.1%-7.9%), 8.0% (95% CI 6.2%-9.8%), and 9.3% (95% CI 6.6%-12.0%), respectively. Male sex (hazard ratio [HR] 2.479, P < 0.001), diabetes mellitus at/before diagnosis of ICP (HR 2.274, P = 0.003), and aged less than 18 years at onset of ICP (HR 0.095, P < 0.001) were identified risk factors for steatorrhea. Initial manifestations were associated with development of steatorrhea. The nomogram was proven to have good concordance indexes. CONCLUSIONS We identified predictors and developed a nomogram for predicting steatorrhea in ICP. It was recommended that high-risk populations be followed up closely, which might contribute to the early diagnosis and treatment of PEI.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiao Yi Yin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhi Qi Dong
- Department of Gastroenterology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Hao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Cui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Di Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jia Yi Ma
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Huai Yu Yang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Juan Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ling Ling Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ya Wei Bi
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yuan Zhang
- Department of Ophthalmology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Qi Sheng Zhang
- Department of Gastroenterology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
| | - Guo Tao Lu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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11
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Nabi Z, Lakhtakia S. Endoscopic management of chronic pancreatitis. Dig Endosc 2021; 33:1059-1072. [PMID: 33687105 DOI: 10.1111/den.13968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/05/2023]
Abstract
Chronic pancreatitis (CP) is an inflammatory process characterized by irreversible morphological changes in the pancreas. Pain is the predominant symptom observed during the course of CP. The etiopathogenesis of pain in CP is multifactorial and includes ductal hypertension due to obstruction of the pancreatic duct (PD), neuropathic causes, and extrapancreatic complications of CP like pseudocyst and distal biliary obstruction. A sizeable proportion of patients with CP are amenable to endoscopic treatment. The mainstay of endotherapy includes decompression of PD with one or more plastic stents in those with stricture, and fragmentation of PD calculi using extracorporeal shock wave lithotripsy. Nearly two-thirds of the patients achieve pain relief in the long term with endotherapy. Upfront assessment for the suitability of endotherapy is paramount to achieve the best outcomes. The predictors of poor response to endotherapy include multifocal disease, like those with multifocal strictures or multiple calculi throughout the pancreas, or a combination of both PD strictures and stones. With the emerging use of covered metal stents, the outcomes are likely to improve in cases with refractory PD strictures as well as CP-related distal biliary obstruction. The optimum stent design and indwell time of metal stents in cases with refractory PD strictures need further evaluation. Endoscopic ultrasonography has emerged as a complementary endoscopic modality in the management of CP as well as associated complications like pseudocysts, refractory pain, and vascular complications.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
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12
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The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis. Acta Gastroenterol Belg 2021; 84:620-626. [PMID: 34965044 DOI: 10.51821/84.4.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.
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13
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Han SY, Papachristou GI, Shah RJ, Conwell DL. Effect of pancreatic endotherapy on quality of life in chronic pancreatitis patients: A systematic review. World J Gastrointest Endosc 2021; 13:336-355. [PMID: 34512881 PMCID: PMC8394180 DOI: 10.4253/wjge.v13.i8.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic endotherapy provides treatment options for the management of chronic pancreatitis-related structural complications such as pancreatic duct stones, strictures, and pancreatic fluid collections. Most studies detailing endotherapy, however, have focused on technical success outcomes such as stone clearance or stricture resolution. AIM To review the effect of pancreatic endotherapy on patient-centered outcomes. METHODS Systematic review of studies examining pancreatic endotherapy. RESULTS A total of 13 studies including 3 randomized clinical trials were included. The majority of studies found an improvement in quality of life with pancreatic endotherapy. CONCLUSION While pancreatic endotherapy does appear to improve quality of life, there are clear gaps in knowledge regarding many pancreatic endotherapy modalities. Furthermore, qualitative analysis is lacking in these studies and further work is needed to elucidate the patient experience with pancreatic endotherapy.
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Affiliation(s)
- Samuel Y Han
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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14
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Mann R, Boregowda U, Vyas N, Gajendran M, Umapathy CP, Sayana H, Echavarria J, Patel S, Saligram S. Current advances in the management of chronic pancreatitis. Dis Mon 2021; 67:101225. [PMID: 34176572 DOI: 10.1016/j.disamonth.2021.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic pancreatitis is characterized by irreversible destruction of pancreatic parenchyma and its ductal system resulting from longstanding inflammation, leading to fibrosis and scarring due to genetic, environmental, and other risk factors. The diagnosis of chronic pancreatitis is made based on a combination of clinical features and characteristic findings on computed tomography or magnetic resonance imaging. Abdominal pain is the most common symptom of chronic pancreatitis. The main aim of treatment is to relieve symptoms, prevent disease progression, and manage complications related to chronic pancreatitis. Patients who do not respond to medical treatment or not a candidate for surgical treatment are usually managed with endoscopic therapies. Endoscopic therapies help with symptoms such as abdominal pain and jaundice by decompression of pancreatic and biliary ducts. This review summarizes the risk factors, pathophysiology, diagnostic evaluation, endoscopic treatment of chronic pancreatitis, and complications. We have also reviewed recent advances in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided therapies for pancreatic duct obstruction due to stones, strictures, pancreatic divisum, and biliary strictures.
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Affiliation(s)
- Rupinder Mann
- Department of Internal Medicine, Saint Agnes Medical Center, 1303 E Herndon Ave, Fresno, CA 93720, USA
| | - Umesha Boregowda
- Department of Internal Medicine, Bassett Healthcare Network, Columbia Bassett Medical School, 1 Atwell Road, Cooperstown, NY 13326, USA
| | - Neil Vyas
- Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Science Center El Paso, 2000B Transmountain Road, El Paso, TX 79911, USA
| | - Chandra Prakash Umapathy
- Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Hari Sayana
- Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Juan Echavarria
- Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Sandeep Patel
- Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Shreyas Saligram
- Department of Gastroenterology and Advanced endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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15
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Hyun JJ, Irani SS, Ross AS, Larsen MC, Gluck M, Kozarek RA. Incidence and Significance of Biliary Stricture in Chronic Pancreatitis Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Stones. Gut Liver 2021; 15:128-134. [PMID: 32393009 PMCID: PMC7817933 DOI: 10.5009/gnl19380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/04/2020] [Accepted: 01/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background/Aims This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi. Methods A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis. SBS was initially managed by either a plastic stent or fully covered self-expandable metallic stent (fcSEMS). If the stricture did not resolve, the stent was replaced with either multiple plastic stents or another fcSEMS. Data were collected by retrospectively reviewing the medical records. Results Biliary strictures were noted in approximately one-third of patients (34/97, 35%) undergoing ESWL for pancreatic calculi. Approximately one-third of the biliary strictures (11/34, 32%) were SBS. Pseudocysts were more frequently found in those with SBS (36% vs 8%, p=0.02), and all pseudocysts in the SBS group were located in the pancreatic head. The initial stricture resolution rates with fcSEMSs and plastic prostheses were 75% and 29%, respectively. The overall success rate for stricture resolution was 73% (8/11), and the recurrence rate after initial stricture resolution was 25% (2/8). Conclusions Although periductal fibrosis is the main mechanism underlying biliary stricture development in chronic pancreatitis, inflammation induced by obstructing pancreatic calculi, including pseudocysts, is an important contributing factor to SBS formation during the acute phase.
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Affiliation(s)
- Jong Jin Hyun
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.,Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Shayan S Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew S Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michael C Larsen
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michael Gluck
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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16
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Saghir SM, Mashiana HS, Mohan BP, Dhindsa BS, Dhaliwal A, Chandan S, Bhogal N, Bhat I, Singh S, Adler DG. Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis. World J Gastroenterol 2020; 26:5207-5219. [PMID: 32982119 PMCID: PMC7495039 DOI: 10.3748/wjg.v26.i34.5207] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients. Per oral pancreatoscopy (POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi (PDC) in chronic pancreatitis. POP uses two techniques: Electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL). Data on the safety and efficacy are limited for this procedure. We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP. The secondary aim was to assess pooled rates of technical success, clinical success for the two individual techniques, and adverse event rates.
AIM To perform a systematic review and meta-analysis of POP, EHL and LL for management of PDC in chronic pancreatitis.
METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Cochrane, Google Scholar and Web of Science databases (from 1999 to October 2019) to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP, EHL and LL. The primary outcome assessed involved the pooled technical success and clinical success rate of POP. The secondary outcome included the pooled technical success and clinical success rate for EHL and LL. We also assessed the pooled rate of adverse events for POP, EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP: Hemorrhage, post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), perforation, abdominal pain, fever and infections. Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain. Random-effects model was used for analysis. Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics. Publication bias was ascertained, qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.
RESULTS A total of 16 studies including 383 patients met the inclusion criteria. The technical success rate of POP was 76.4% (95%CI: 65.9-84.5; I2 = 64%) and clinical success rate was 76.8% (95%CI: 65.2-85.4; I2 = 66%). The technical success rate of EHL was 70.3% (95%CI: 57.8-80.3; I2 = 36%) and clinical success rate of EHL was 66.5% (95%CI: 55.2-76.2; I2 = 19%). The technical success rate of LL was 89.3% (95%CI: 70.5-96.7; I2 = 70%) and clinical success rate of LL was 88.2% (95%CI: 66.4-96.6; I2 = 77%). The incidence of pooled adverse events for POP was 14.9% (95%CI: 9.2-23.2; I2 = 49%), for EHL was 11.2% (95%CI: 5.9-20.3; I2 = 15%) and for LL was 13.1% (95%CI: 6.3-25.4; I2 = 31%). Subgroup analysis of adverse events showed rates of PEP at 7% (95%CI: 3.5-13.6; I2 = 38%), fever at 3.7% (95%CI: 2-6.9; I2 = 0), abdominal pain at 4.7% (95%CI: 2.7-7.8; I2 = 0), perforation at 4.3% (95%CI: 2.1-8.4; I2 = 0), hemorrhage at 3.4% (95%CI: 1.7-6.6; I2 = 0) and no mortality. There was evidence of publication bias based on funnel plot analysis and Egger’s test.
CONCLUSION Our study highlights the high technical and clinical success rates for POP, EHL and LL. POP-guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.
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Affiliation(s)
- Syed M Saghir
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Harmeet S Mashiana
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, United States
| | - Banreet S Dhindsa
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Neil Bhogal
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, United States
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17
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Kitano M, Gress TM, Garg PK, Itoi T, Irisawa A, Isayama H, Kanno A, Takase K, Levy M, Yasuda I, Lévy P, Isaji S, Fernandez-Del Castillo C, Drewes AM, Sheel ARG, Neoptolemos JP, Shimosegawa T, Boermeester M, Wilcox CM, Whitcomb DC. International consensus guidelines on interventional endoscopy in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020; 20:1045-1055. [PMID: 32792253 DOI: 10.1016/j.pan.2020.05.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES This paper is part of the international consensus guidelines on chronic pancreatitis, presenting for interventional endoscopy. METHODS An international working group with experts on interventional endoscopy evaluated 26 statements generated from evidence on 9 clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the level of evidence. To determine the level of agreement, a nine-point Likert scale was used for voting on the statements. RESULTS Strong consensus was obtained for 15 statements relating to nine questions including the recommendation that endoscopic intervention should be offered to patients with persistent severe pain but not to those without pain. Endoscopic decompression of the pancreatic duct could be used for immediate pain relief, and then offered surgery if this fails or needs repeated endoscopy. Endoscopic drainage is preferred for portal-splenic vein thrombosis and pancreatic fistula. A plastic stent should be placed and replaced 2-3 months later after insertion. Endoscopic extraction is indicated for stone fragments remaining after ESWL. Interventional treatment should be performed for symptomatic/complicated pancreatic pseudocysts. Endoscopic treatment is recommended for bile duct obstruction and afterwards surgery if this fails or needs repeated endoscopy. Surgery may be offered if there is significant calcification and/or mass of the pancreatic head. Percutaneous endovascular treatment is preferred for hemosuccus pancreaticus. Surgical treatment is recommended for duodenal stenosis due to chronic pancreatitis. CONCLUSIONS This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis.
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Affiliation(s)
- Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Thomas M Gress
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital, Philipps-Universität Marburg, Marburg, Germany.
| | - Pramod K Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan.
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
| | - Atsushi Kanno
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Michael Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | - Phillipe Lévy
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, DHU UNITY, Hôpital Beaujon, APHP, Clichy Cedex, Université Paris 7, France.
| | - Shuiji Isaji
- Department of Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
| | | | - Asbjørn M Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
| | - Andrea R G Sheel
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - John P Neoptolemos
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Marja Boermeester
- Department of Surgery, Amsterdam University Medical Centers, location AMC, and Amsterdam Gastroenterology & Metabolism, Amsterdam, the Netherlands.
| | - C Mel Wilcox
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David C Whitcomb
- Departments of Medicine, Cell Biology & Molecular Physiology and Human Genetics, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA.
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18
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van Huijgevoort NC, Veld JV, Fockens P, Besselink MG, Boermeester MA, Arvanitakis M, van Hooft JE. Success of extracorporeal shock wave lithotripsy and ERCP in symptomatic pancreatic duct stones: a systematic review and meta-analysis. Endosc Int Open 2020; 8:E1070-E1085. [PMID: 32743061 PMCID: PMC7373664 DOI: 10.1055/a-1171-1322] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Nadine C.M. van Huijgevoort
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Joyce V. Veld
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Marc G. Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Marianna Arvanitakis
- Department of Gastroenterology and Hepatology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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19
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Liu Y, Wang D, Cai YL, Zhang T, Chen HL, Hao L, Wang T, Zhang D, Yang HY, Ma JY, Li J, Zhang LL, Chen C, Guo HL, Bi YW, Xin L, Zeng XP, Chen H, Xie T, Liao Z, Cong ZJ, Li ZS, Hu LH. Classification of Early-Onset and Late-Onset Idiopathic Chronic Pancreatitis Needs Reconsideration. Sci Rep 2020; 10:10448. [PMID: 32591619 PMCID: PMC7320187 DOI: 10.1038/s41598-020-67306-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/05/2020] [Indexed: 12/23/2022] Open
Abstract
Bimodal classification of idiopathic chronic pancreatitis (ICP) into early-onset (<35 years) and late-onset (>35 years) ICP was proposed in 1994 based on a study of 66 patients. However, bimodal distribution wasn’t sufficiently demonstrated. Our objective was to examine the validity and relevance of the age-based bimodal classification of ICP. We analyzed the distribution of age at onset of ICP in our cohort of 1633 patients admitted to our center from January 2000 to December 2013. Classify ICP patients into early-onset ICP(a) and late-onset ICP(a) according to different cut-off values (cut-off value, a = 15, 25, 35, 45, 55, 65 years old) for age at onset. Compare clinical characteristics of early-onset ICP(a) and late-onset ICP(a). We found slightly right skewed distribution of age at onset for ICP in our cohort. There were differences between early-onset and late-onset ICP with respect to basic clinical characteristics and development of key clinical events regardless of the cut off age at onset i.e. 15, 25, 35, 45 or even higher. The validity of the bimodal classification of early-onset and late-onset ICP could not be established in our large patient cohort and therefore such a classification needs to be reconsidered.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Yi-Li Cai
- School of Basic medical sciences, The Second Military Medical University, Shanghai, 200433, China
| | - Tao Zhang
- School of Basic medical sciences, The Second Military Medical University, Shanghai, 200433, China
| | - Hua-Liang Chen
- School of Basic medical sciences, The Second Military Medical University, Shanghai, 200433, China
| | - Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Di Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Huai-Yu Yang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Jia-Yi Ma
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Juan Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Ling-Ling Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Cui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Hong-Lei Guo
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Ya-Wei Bi
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Hui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, 210000, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Zhi-Jie Cong
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200120, China
| | - Zhao-Shen Li
- School of Basic medical sciences, The Second Military Medical University, Shanghai, 200433, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China.
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20
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Udd M, Kylänpää L, Kokkola A. The Role of Endoscopic and Surgical Treatment in Chronic Pancreatitis. Scand J Surg 2020; 109:69-78. [DOI: 10.1177/1457496920910009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic pancreatitis is a long-term illness leading to hospital admissions and readmission. This disease is often caused by heavy alcohol consumption and smoking. Patients with chronic pancreatitis suffer from acute or chronic pain episodes, recurrent pancreatitis, and complications, such as pseudocysts, biliary duct strictures, and pancreatic duct fistulas. Pancreatic duct strictures and stones may increase intraductal pressure and cause pain. Endoscopic therapy is aiming at decompressing the pressure and relieving the pain, most commonly with pancreatic duct stents and pancreatic duct stone retrieval. Early surgery is another option to treat the pain. In addition, endotherapy has been successful in treating complications related to chronic pancreatitis. The therapy should be individually chosen in a multidisciplinary meeting. Endoscopic therapy and surgery as treatment options for chronic pancreatitis are discussed in this review.
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Affiliation(s)
- M. Udd
- Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L. Kylänpää
- Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A. Kokkola
- Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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21
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Liu Y, Wang D, Guo HL, Hao L, Wang T, Zhang D, Yang HY, Ma JY, Li J, Zhang LL, Lin K, Chen C, Han X, Lin JH, Bi YW, Xin L, Zeng XP, Chen H, Xie T, Liao Z, Cong ZJ, Wang LS, Xu ZL, Li ZS, Hu LH. Risk factors and nomogram for diabetes mellitus in idiopathic chronic pancreatitis. J Gastroenterol Hepatol 2020; 35:343-352. [PMID: 31318997 DOI: 10.1111/jgh.14785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Diabetes mellitus (DM) is a common complication of idiopathic chronic pancreatitis (ICP), which impairs the quality of life for patients. This study aimed to identify risk factors and develop nomogram for DM in ICP to help early diagnosis. METHODS Idiopathic chronic pancreatitis patients admitted to our center from January 2000 to December 2013 were included. Cumulative rates of DM were calculated by Kaplan-Meier method. Patients were randomly assigned, in a 2:1 ratio, to the training and validation cohort. Based on training cohort, risk factors for DM were identified through Cox proportional hazards regression model, and nomogram was developed. Internal and external validations were performed based on the training and validation cohort, respectively. RESULTS Totally, 1633 patients with ICP were finally enrolled. The median follow-up duration was 9.8 years. DM was found in 26.3% (430/1633) of patients after the onset of CP. Adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct were identified risk factors for DM development. The nomogram achieved good concordance indexes in the training and validation cohorts, respectively, with well-fitted calibration curves. CONCLUSIONS Risk factors were identified, and nomogram was developed to determine the risk of DM in ICP patients. Patients with one or more of the risk factors including adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct have higher incidence of DM.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hong-Lei Guo
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Teng Wang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Di Zhang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Huai-Yu Yang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jia-Yi Ma
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Juan Li
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ling-Ling Zhang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Kun Lin
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Cui Chen
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xu Han
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jin-Huan Lin
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ya-Wei Bi
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhuan Liao
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhi-Jie Cong
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Li-Sheng Wang
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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22
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Liu Y, Hao L, Wang T, Li ZS, Xu ZL, Hu LH. Colonic hematoma after extracorporeal shock wave lithotripsy for pancreatic stones: a case report. BMC Gastroenterol 2019; 19:208. [PMID: 31801483 PMCID: PMC6894139 DOI: 10.1186/s12876-019-1117-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/13/2019] [Indexed: 01/22/2023] Open
Abstract
Background Despite pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is a minimally invasive treatment for pancreatic stones, complications exist. Case presentation A 37-year-old male was diagnosed with chronic pancreatitis and admitted to our hospital for recurrent acute pancreatitis. After the first P-ESWL session, the patient complained of a new type of pain different from the previous pain pattern. Computerized tomography and colonoscopy were arranged and colonic hematoma was found. Since the patient had stable vital signs, no special treatment was given focusing on the colonic hematoma. Five days later, P-ESWL treatment was repeatedly performed for four consecutive days. Two days after the last P-ESWL session, the patient underwent endoscopic retrograde cholangiopancreatography. At the three-month follow up visit, the colonic hematoma disappeared and pancreatic stones decreased significantly. Conclusions To the best of our knowledge, colonic hematoma after P-ESWL for pancreatic stones has never been reported. Here, we present the only case of colonic hematoma after P-ESWL, which was coincidentally found in more than 6000 P-ESWL sessions in our hospital. As the symptoms of colonic hematoma are mild, we believe the incidence of colonic hematoma has been underestimated. Many people with colonic hematoma after P-ESWL may be undiagnosed or misdiagnosed. Treatment for colonic hematoma depends on whether there is severe clinical state. Exploration of more precise location method for pancreatic stones may reduce the probability of P-ESWL complication.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Teng Wang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China. .,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
| | - Zheng-Lei Xu
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, 1017 North Dongmen Road, Shenzhen, Guangdong, China.
| | - Liang-Hao Hu
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China. .,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
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23
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Abstract
PURPOSE OF REVIEW Pancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis. Stone resolution has shown to improve pain. The goal of this review is to highlight recent endoscopic and surgical advancements in treatment of pancreatic duct stones. RECENT FINDINGS Stone fragmentation by extracorporeal shock wave lithotripsy has become first line and the mainstay of treatment for majority of patients with pancreatic duct stones. Introduction of digital video pancreatoscopy in the last few years with the capability of guided lithotripsy has provided a robust therapeutic option where extracorporeal shock wave lithotripsy is unsuccessful or unavailable. Historically, surgery has been considered a more reliable and durable option when feasible. However, it had not been compared with more effective endoscopic therapy. Lithotripsy (extracorporeal and pancreatoscopy guided) is evolving as a strong treatment modality for pancreatic stones.
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Affiliation(s)
- Kaveh Sharzehi
- Division of Gastroenterology & Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
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24
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Xie T, Hao L, Liu Y, Zhang D, Bi YW, Wang T, Zeng XP, Xin L, Pan J, Wang D, Ji JT, Du TT, Lin JH, Zou WB, Chen H, Guo HL, Li BR, Cong ZJ, Liao Z, Wan R, Li ZS, Hu LH. Risk factor for diabetes mellitus in pediatric chronic pancreatitis patients. Medicine (Baltimore) 2019; 98:e17984. [PMID: 31770208 PMCID: PMC6890329 DOI: 10.1097/md.0000000000017984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pediatric patients suffer from chronic pancreatitis (CP), especially those with diabetes mellitus (DM). This study aimed to identify the incidence of and risk factors for DM in pediatric CP.CP patients admitted to our center from January 2000 to December 2013 were assigned to the pediatric (<18 years old) and adult group according to their age at onset of CP. Cumulative rates of DM and risk factors for both groups were calculated and identified.The median follow-up duration for the whole cohort was 7.6 years. In these 2153 patients, 13.5% of them were pediatrics. The mean age at the onset and the diagnosis of CP in pediatrics were 11.622 and 19.727, respectively. DM was detected in 13.1% patients and 31.0% patients in the pediatric group and adult group, respectively. Age at the onset of CP, smoking history, body mass index (BMI), and etiology of CP were identified risk factors for DM in pediatrics.DM was detected in 13.1% pediatric patients. Age at the onset of CP, smoking history, BMI, and etiology of CP were identified risk factors for the development of DM in pediatric CP patients. The high-risk populations were suggested to be monitored frequently. They could also benefit from a lifestyle modification.
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Affiliation(s)
- Ting Xie
- Department of Gastroenterology, Shanghai General Hospital of Nanjing Medical University, Shanghai
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing
| | - Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Endoscopy Center, Changhai Hospital
| | - Yu Liu
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Di Zhang
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Ya-Wei Bi
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Teng Wang
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Lei Xin
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Jun Pan
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Dan Wang
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | | | | | - Jin-Huan Lin
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Wen-Bin Zou
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Hui Chen
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Hong-Lei Guo
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Bai-Rong Li
- Department of Gastroenterology, Air Force General Hospital, Beijing
| | - Zhi-Jie Cong
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Rong Wan
- Department of Gastroenterology, Shanghai General Hospital of Nanjing Medical University, Shanghai
| | - Zhao-Shen Li
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Liang-Hao Hu
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
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25
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Reply to Comment on Zeng et al, Spatial Distribution of Pancreatic Stones in Chronic Pancreatitis. Pancreas 2019; 48:e59. [PMID: 31306309 DOI: 10.1097/mpa.0000000000001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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26
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Risk factor for steatorrhea in pediatric chronic pancreatitis patients. BMC Gastroenterol 2018; 18:182. [PMID: 30518343 PMCID: PMC6280450 DOI: 10.1186/s12876-018-0902-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pediatric patients always suffer from chronic pancreatitis (CP), especially those with steatorrhea. This study aimed to identify the incidence of and risk factors for steatorrhea in pediatric CP. To our best knowledge, there is no pediatric study to document the natural history of steatorrhea in CP. METHODS CP patients admitted to our center from January 2000 to December 2013 were enrolled. Patients were assigned to the pediatric (< 18 years old) and adult group according to their age at onset of CP. Cumulative rates of steatorrhea in both groups were calculated. Risk factors for both groups were identified, respectively. RESULTS The median follow-up duration for the whole cohort was 7.6 years. In a total of 2153 patients, 13.5% of them were pediatrics. The mean age at the onset and the diagnosis of CP in pediatrics were 11.622 and 19.727, respectively. Steatorrhea was detected in 46 patients (46/291, 15.8%) in the pediatric group and in 447 patients (447/1862, 24.0%) in the adult group. Age at the onset of CP (hazard ratio [HR], 1.121), diabetes mellitus (DM, HR, 51.140), and severe acute pancreatitis (SAP, HR, 13.946) was identified risk factor for steatorrhea in the pediatric group. CONCLUSIONS Age at the onset of CP, DM and SAP were identified risk factors for the development of steatorrhea in pediatric CP patients. The high-risk populations were suggested to be followed up closely. They may benefit from a full adequate pancreatic exocrine replacement therapy.
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27
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Liu Y, Hao L, Wang LS, Wang T, Li ZS, Hu LH, Xu ZL. Large mesenteric hematoma after extracorporeal shock wave lithotripsy for pancreatic stones: A case report. Medicine (Baltimore) 2018; 97:e13114. [PMID: 30383702 PMCID: PMC6221730 DOI: 10.1097/md.0000000000013114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Mesenteric hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones is a very rare complication which has never been reported before. PRESENTING CONCERNS We reported a case of a 36-year-old male diagnosed as chronic pancreatitis with pancreatic stones and a large pancreatic pseudocyst. He underwent 3 repeated sessions of pancreatic ESWL (P-ESWL). After the last session of P-ESWL, he complained of dizziness. Physical examination revealed a large mass in the right abdomen. DIAGNOSIS Emergent upper abdominal computerized tomography (CT) revealed this mass is a mesenteric hematoma with the size of 8.2 cm × 11.7 cm in the right abdominal cavity after P-ESWL and there was no sign of intestinal obstruction. INTERVENTIONS With close monitoring of vital signs, the patient received conservative treatment for several days. Dynamic abdominal ultrasound monitoring revealed the mesenteric hematoma had organized. OUTCOMES Vital signs of the patient were stable after fluid transfusion. Three-month follow-up CT showed the mesenteric hematoma had absorbed completely. LESSONS Mesenteric hematoma rarely occurs after P-ESWL and it alerts us the importance of considering uncommon complications after P-ESWL. If mesenteric hematoma occurs after P-ESWL, conservative treatment could be the first choice while surgery can also be considered.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Lu Hao
- Department of Gastroenterology, Hainan Branch of Chinese PLA General Hospital, Sanya
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Li-Sheng Wang
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong, China
| | - Teng Wang
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Zhao-Shen Li
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Liang-Hao Hu
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Zheng-Lei Xu
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong, China
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28
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Abstract
OBJECTIVES The aim of this study was to establish a standard to describe the spatial distribution of pancreatic stones in chronic pancreatitis (CP). METHODS 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. RESULTS 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. CONCLUSIONS Compared with idiopathic CP, alcoholic CP patients were prone to more pancreatic stones that distribute more uniformly.
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29
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Hao L, Wang LS, Liu Y, Wang T, Guo HL, Pan J, Wang D, Bi YW, Ji JT, Xin L, Du TT, Lin JH, Zhang D, Zeng XP, Zou WB, Chen H, Xie T, Li BR, Liao Z, Cong ZJ, Xu ZL, Li ZS, Hu LH. The different course of alcoholic and idiopathic chronic pancreatitis: A long-term study of 2,037 patients. PLoS One 2018; 13:e0198365. [PMID: 29883461 PMCID: PMC5993321 DOI: 10.1371/journal.pone.0198365] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background Chronic pancreatitis (CP) is a chronic inflammatory disease of the pancreas. This study aimed to compare the natural course of alcoholic chronic pancreatitis (ACP) and idiopathic chronic pancreatitis (ICP). Methods CP patients admitted to our center from January 2000 to December 2013 were enrolled. Characteristics were compared between ACP and ICP patients. Cumulative rates of diabetes mellitus (DM), steatorrhea, pancreatic stone, pancreatic pseudocyst, biliary stricture, and pancreatic cancer after the onset and the diagnosis of CP were calculated, respectively. The cumulative rates of DM and steatorrhea after diagnosis of pancreatic stone were also calculated. Results A total of 2,037 patients were enrolled. Among them, 19.8% (404/2,037) were ACP and 80.2% (1,633/2,037) were ICP patients. ACP and ICP differs in many aspects, especially in gender, age, smoking, complications, morphology of pancreatic duct, and type of pain. The development of DM, steatorrhea, PPC, pancreatic stone, and biliary stricture were significantly earlier and more common in ACP patients. No significant difference was observed for pancreatic cancer development. There was a rather close correlation between exocrine/endocrine insufficiency and pancreatic stone in ACP patients, which was much less correlated in ICP patients. Conclusion The long-term profile of ACP and ICP differs in some important aspects. ACP patients usually have a more severe course of CP. These differences should be recognized in the diagnosis and treatment of CP.
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Affiliation(s)
- Lu Hao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Li-Sheng Wang
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People’s Hospital), Jinan University, Guangdong, China
| | - Yu Liu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hong-Lei Guo
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ya-Wei Bi
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun-Tao Ji
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting-Ting Du
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jin-Huan Lin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Di Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bai-Rong Li
- Department of Gastroenterology, Air Force General Hospital, Beijing, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhi-Jie Cong
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People’s Hospital), Jinan University, Guangdong, China
- * E-mail: (LHH); (ZSL); (ZLX)
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
- * E-mail: (LHH); (ZSL); (ZLX)
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
- * E-mail: (LHH); (ZSL); (ZLX)
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30
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Bi YW, Wang D, Du TT, Liao Z, Li ZS, Hu LH. Hepatic subcapsular hematoma breaking into the abdominal cavity after extracorporeal shock wave lithotripsy for pancreatic stones. J Dig Dis 2018; 19:314-317. [PMID: 28749071 DOI: 10.1111/1751-2980.12510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Ya Wei Bi
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ting Ting Du
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liang Hao Hu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
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31
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Extracorporeal Shock Wave Lithotripsy for Chronic Pancreatitis Patients With Stones After Pancreatic Surgery. Pancreas 2018; 47:609-616. [PMID: 29683971 DOI: 10.1097/mpa.0000000000001042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the safety and efficacy of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) in chronic pancreatitis (CP) patients with pancreatic stones after previous pancreatic surgery. METHODS This is a single-center study prospectively conducted in pained CP patients undergoing P-ESWL. Patients with a pancreatic surgery history (PSH) were included in the PSH group, and patients without a PSH during the same period were assigned to the control group. The primary outcomes included complications associated with P-ESWL and pain relief. Secondary outcomes included stone clearance and improved quality-of-life scores. RESULTS From March 2011 to October 2014, P-ESWLs were performed on 1017 patients (50 in the PSH group, 967 in the control group). No significant difference was observed in the frequency of occurrence of P-ESWL complications between the PSH group and control group (14.0% vs 13.2%, P = 0.877). At follow-up (2.6 years; range, 1.0-4.5 years), pain relief was achieved in 36 patients (75.0%), and 37 patients (77.1%) experienced complete stone clearance. No significant differences were observed between these patients and the matched controls. CONCLUSIONS For CP patients who develop painful stones after pancreatic surgery, P-ESWL safely achieves significant pain relief and stone clearance, preventing the need for a repeat surgery.
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32
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Hao L, Liao Z, Hu LH. Chronic Pancreatitis Prognosis Score System Is Not Ready Yet. Gastroenterology 2018; 154:1852-1853. [PMID: 29621518 DOI: 10.1053/j.gastro.2017.11.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/21/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Lu Hao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology and Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology and Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
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33
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Qian YY, Chen H, Tang XY, Jiang X, Qian W, Zou WB, Xin L, Li B, Qi YF, Hu LH, Zou DW, Jin ZD, Wang D, Du YQ, Wang LW, Liu F, Li ZS, Liao Z. Rectally administered indomethacin to prevent post-ESWL-pancreatitis (RIPEP): study protocol for a randomized controlled trial. Trials 2017; 18:513. [PMID: 29096689 PMCID: PMC5667485 DOI: 10.1186/s13063-017-2250-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is the first-line therapy for large pancreatic duct stones. Although it is a highly effective and safe procedure for the fragmentation of pancreatic stones, it is still not complication-free. Just like endoscopic retrograde cholangiopancreatography (ERCP), pancreatitis is the most common complication. To date, nonsteroidal anti-inflammatory drugs (NSAIDs) have proven to be the only effective prophylactic medication for post-ERCP pancreatitis and the European, American and Japanese Society for Gastrointestinal Endoscopy guidelines have recommended prophylactic rectally administered indomethacin for all patients undergoing ERCP. Given the little research about effective prevention for post P-ESWL pancreatitis, we aim to determine whether rectally administered indomethacin can reduce post-ESWL-pancreatitis. METHODS/DESIGN The RIPEP study is a prospective, randomized, double-blinded, placebo-controlled trial. One thousand three hundred and seventy patients with chronic pancreatitis and pancreatic stones (>5 mm in diameter) treated with P-ESWL at Changhai Hospital will be randomly allocated to rectally administered indomethacin or placebo therapy before the procedure. The primary endpoint is the incidence of post-ESWL pancreatitis. Secondary endpoints include the severity of pancreatitis, occurrence rate of asymptomatic hyperamylasemia and other complications. DISCUSSION The RIPEP trial is designed to show that rectally administered indomethacin reduces the development and severity of post-ESWL pancreatitis and benefits patients treated with P-ESWL. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02797067 . Registered on 17 November 2016.
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Affiliation(s)
- Yang-Yang Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Hui Chen
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Xin-Ying Tang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Xi Jiang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Wei Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Lei Xin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Bo Li
- Department of Anesthesiology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Yan-Fen Qi
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Duo-Wu Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhen-Dong Jin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Dong Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Yi-Qi Du
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Luo-Wei Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Feng Liu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
- National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433 China
- Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
- National Clinical Research Center of Digestive Diseases, Shanghai, China
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34
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Hao L, Zeng XP, Xin L, Wang D, Pan J, Bi YW, Ji JT, Du TT, Lin JH, Zhang D, Ye B, Zou WB, Chen H, Xie T, Li BR, Zheng ZH, Wang T, Guo HL, Liao Z, Li ZS, Hu LH. Incidence of and risk factors for pancreatic cancer in chronic pancreatitis: A cohort of 1656 patients. Dig Liver Dis 2017; 49:1249-1256. [PMID: 28756974 DOI: 10.1016/j.dld.2017.07.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risk of pancreatic cancer may increase in chronic pancreatitis patients. AIMS This study aimed to identify the incidence of and risk factors for pancreatic cancer in chronic pancreatitis patients. METHODS Chronic pancreatitis patients admitted to our center from January 2000 to December 2013 were enrolled. Cumulative rates of pancreatic cancer and survival rates were calculated. The standardized incidence ratio was calculated based on the pancreatic cancer incidence in general population of China. Risk factors for pancreatic cancer were identified. RESULTS In a total of 1656 patients, the median follow-up duration was 8.0 years. Pancreatic cancer was detected in 21 patients (1.3%). The expected number of cases of pancreatic cancer was 1.039, yielding a standardized incidence ratio of 20.22. The standardized incidence ratios for patients with a >60 pack-year smoking history were much higher (145.82). Two risk factors for pancreatic cancer were identified: age at the onset of chronic pancreatitis (hazard ratio, 1.05) and a >60 pack-year smoking history (hazard ratio, 11.83). CONCLUSION The risk of pancreatic cancer is markedly increased in chronic pancreatitis patients compared with the general population, especially in patients with an older age at onset and a >60 pack-year smoking history. The high-risk populations were suggested to be followed up closely.
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Affiliation(s)
- Lu Hao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ya-Wei Bi
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun-Tao Ji
- Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting-Ting Du
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jin-Huan Lin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Di Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Bo Ye
- Department of surgery, Jinling Hospital, Nanjing, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bai-Rong Li
- Department of Gastroenterology, Air Force General Hospital, Beijing, China
| | - Zhao-Hong Zheng
- Department of Traditional Chinese Medicine, Jiangdu Hospital, Yangzhou, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hong-Lei Guo
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
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Abstract
PURPOSE OF REVIEW Summarize key clinical advances in chronic pancreatitis reported in 2016. RECENT FINDINGS Early diagnosis of chronic pancreatitis remains elusive. Recent studies suggest that endoscopic ultrasound may be less accurate than previously thought and new MRI techniques may be helpful. Genetic predisposition may independently affect the clinical course of chronic pancreatitis and the risk for pancreatic cancer. Cigarette smoking may have a greater negative impact on chronic pancreatitis than previously thought and moderate alcohol consumption may be protective. A multidisciplinary approach is necessary for the treatment of type 3 diabetes and nutritional deficiencies in chronic pancreatitis. Although endoscopic therapy remains a reasonable first-line option in treating chronic pancreatitis and its complications, early surgical intervention may be indicated for pain in select patients. SUMMARY Newer endoscopic ultrasound and MRI techniques are being evaluated to help with the early diagnosis of chronic pancreatitis. Both genetic predisposition and cigarette smoking are increasingly recognized as having a major impact in the course of the disease and the risk for pancreatic cancer. Endoscopic therapy is well tolerated and effective for the treatment of chronic pancreatitis and its complications although an early surgical approach for pain may be associated with improved clinical outcomes.
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Korpela T, Udd M, Tenca A, Lindström O, Halttunen J, Myrskysalo S, Mikkola A, Kylänpää L. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol 2016; 51:866-71. [PMID: 26912383 DOI: 10.3109/00365521.2016.1150502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Extracorporeal shock wave lithotripsy (ESWL) combined with endotherapy (ET) is the standard treatment for pancreatic duct stones (PDS) in chronic pancreatitis (CP). Our aim was to report the short- and long-term results of ESWL and ET. MATERIAL AND METHODS Consecutively treated 83 patients with symptomatic PDS using ESWL and ET. Success was defined (i) technically: PDS fragmentation and clearance obtained and (ii) clinically: improvement/resolution of pain. To get information on quality of life, we conducted a phone survey whereby we contacted 64 (89%) patients. The long-term results are presented in those patients with ≥2 years follow-up. RESULTS Treated PDS with median size of 10 (5-25) mm were located in the head, body, or the tail of the pancreas in 78, 4, and 1 patients, respectively. The primary results were that technical success was achieved in 69 patients (83%) and clinical success in 66 patients (80%). Fourteen patients had technical failure, but eight of them became free of pain. Thus, clinical success can be considered to have been achieved in 74 of 83 patients (89%). In patients with persistent pseudocyst (PC) at the time of ESWL (n = 19), the PC disappeared in a year in 14 patients (74%). The long-term results were obtained from 61 (73%) ESWL- and ET-treated patients. The median follow-up for them was 53 months (range: 24-124) and 57 patients (93%) became pain-free or had less pain. CONCLUSIONS For patients with CP and PDS ESWL combined with ET is an effective and safe treatment giving favorable long-term results.
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Affiliation(s)
- Taija Korpela
- a Department of Surgery , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Marianne Udd
- a Department of Surgery , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Andrea Tenca
- b Department of Gastroenterology , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Outi Lindström
- a Department of Surgery , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Jorma Halttunen
- a Department of Surgery , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Sanna Myrskysalo
- c Department of Urology , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Arto Mikkola
- c Department of Urology , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Leena Kylänpää
- a Department of Surgery , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
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Bhandari S, Maydeo A. Extracorporeal shock wave lithotripsy: the cornerstone of pancreatic endotherapy. Gastrointest Endosc 2016; 84:79-80. [PMID: 27315735 DOI: 10.1016/j.gie.2016.03.1494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/26/2016] [Indexed: 02/05/2023]
Affiliation(s)
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Mumbai, India
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38
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Li BR, Pan J, Hu LH, Li ZS. Laser lithotripsy as a supplementary approach for the treatment of main pancreatic duct stones. Gastrointest Endosc 2016; 83:1300-1. [PMID: 27206592 DOI: 10.1016/j.gie.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Bai-Rong Li
- Department of Gastroenterology, Air Force General Hospital, Beijing, China; Department of Gastroenterology and Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology and Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology and Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology and Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
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