Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE trial): study protocol for a randomized, sham-controlled trial

Background

Pain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) has been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clinical pain symptoms correlate poorly with pancreatic duct morphology, and the evidence for pancreatic duct decompression as an effective treatment for pain is based on case series and comparison between different procedures. No randomized, prospective, sham-controlled trials are currently available. The SCHOKE (Extracorporeal Shock Wave Lithotripsy and Endotherapy for Pain in Chronic Pancreatitis) trial is a randomized, sham-controlled trial designed to determine if pancreatic duct decompression is an effective treatment for pain in patients with CP.

Methods

The SCHOKE trial is a randomized, single-blind, parallel-group, sham-controlled trial designed to evaluate the effect of combined ESWL and endoscopic treatment for pain in patients with CP. In total, 106 adult patients with painful CP and pancreatic duct obstruction will be randomized to combined ESWL and subsequent endoscopic treatment or corresponding sham procedures. The primary outcome is pain relief during the 3-month postrandomization period as documented in a pain diary. Secondary outcomes include quality of life and functional scores, patient global impression of change, change in use of analgesics, frequency of hospitalization, and complications. Standard follow-up is at 3 and 6 months after randomization. In an experimental substudy, quantitative sensory testing obtained before and after intervention will be used to obtain information on central pain processing and to develop models for prediction of treatment outcome.

Discussion

The SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.

Trial registration

ClinicalTrials.gov, NCT03966781. Registered on May 25, 2019.

Protocol date and version identifier: March 1, 2020; version 3.0.

Sponsor: Rupjyoti Talukdar, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.

[A methodological study in a space flight simulation context]

To study the effects of isolation and confinement on small groups during long space flights, it is habitual to use closed hyperbaric ground chambers. For the first time, the European Space Agency made use of a nautral environment taking advantage of an Antarctic winter-over at the French Dumont d'Urville Station. The main objective of that study ("International Antarctic Psychological Programme"), was to compare different Russian tests used for training cosmonauts to a W. European approach validated during previous winter studies and European ground chamber simulations. Russian techniques appeared to be oriented to a narrow range of phenomena and unsuited to discern the adjustment to stress conditions.

Decreased serum levels of 1,25-(OH)2 vitamin D during 1 year of sunlight deprivation in the Antarctic

French Antarctic territories harbor bases that are devoted to scientific and technical work. Living and working conditions during 1-year sojourns in such an environment are quite acceptable, but the confinement and the drop in ultraviolet B radiation exposure during winter months raise the problem of preservation of normal vitamin D status. Seasonal variations in 25-hydroxyvitamin D [25(OH)D] levels have been well documented, but the effect of sunshine deprivation on 1,25 dihydroxyvitamin D [1,25(OH)2D] levels is quite controversial. The aim of this study was to address this question under the exceptional conditions of lack of sunshine exposure. Fifteen male Caucasian subjects participating in a 1-year mission in Antarctica were investigated. They were subjected to seven blood samplings, one before and six during their sojourn. Serum levels of 25(OH)D, 1,25(OH)2D, osteocalcin, and ICTP were measured. We found that levels of 25(OH)D and 1,25(OH)2D significantly decreased in these subjects during the mission, minimum levels being observed 10 months after their departure from France. ICTP concentrations did not change throughout this study, but osteocalcin levels were found to be higher at the end of the sojourn than before departure, which could argue for the existence of bone remodeling changes. Further studies are now needed to fully investigate bone metabolism changes and to address the question of vitamin D supplementation during this kind of sojourn.

[The reaction to viewing slides on tropical medicine. Evaluation study]

A series of slides on health priorities in Africa was shown to an audience of 123 people, of which 19 were not medical specialists. The authors of this experiment wanted to verify that the objectives set by the producers were met. The study, conducted in the form of a questionnaire, asked the people questioned to give their opinion on the objectives, the kind of public aimed at, the standard of the various subjects covered and the usefulness and cost-efficiency ratio of the type of audio-visual equipment used. Although the analysis of collected data reveals certain discrepancies as to the professional status of those questioned, the vast majority of participants considered this documentary support to be extremely worthwhile.