Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success.
BACKGROUND
The aim of the study was to evaluate interventional endoscopic management of pancreatic duct stones in patients with chronic pancreatitis by describing therapeutic methods and defining factors that predict technical success.


METHODS
Records were retrospectively analyzed for 125 patients with symptoms caused by chronic pancreatitis with pancreatic duct stones (single 43, multiple 82) treated by interventional endoscopy, including extracorporeal shockwave lithotripsy.


RESULTS
Technical success was achieved in 85% of patients (11 patients by mechanical lithotripsy, 114 by piezoelectric extracorporeal shockwave lithotripsy). There were no serious complications from lithotripsy. Univariate analysis disclosed a statistically significant association between treatment success and patient age as well as prepapillary location of stones. A greater therapeutic effort was necessary in patients with stones located in the tail of the pancreas, 2 or more stones, a stone 12 mm or more in diameter, or who have had a longer duration (>8 years) of the disease. However, with exception of the last parameter, correction for multiple testing of data removed statistical significance.


CONCLUSIONS
Extracorporeal shockwave lithotripsy enhances endoscopic measures for treatment of pancreatic duct stones when mechanical lithotripsy fails. Middle-aged patients in the early stages of chronic pancreatitis with stones in a prepapillary location proved to be the best candidates for successful treatment. Unfavorable patient-related or morphologic factors can be compensated for through more intense efforts at therapy.
Farnbacher
Michael J
MJ
Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
Schoen
Christoph
C
Rabenstein
Thomas
T
Benninger
Johannes
J
Hahn
Eckhart G
EG
Schneider
H Thomas
HT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002137:Calculi / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome