Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis.
BACKGROUND
Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment.


METHODS
We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1 November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used.


RESULTS
Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months, 35% of all patients were pain-free and a further 6% were not using analgesics. Seven patients no longer needed opioids during follow-up, but five other patients needed addition of opioids to treatment. The median opioid dose among opioid-dependent patients rose slightly (9%). The median increase of weight after treatment was 1 kg per year.


CONCLUSIONS
After decompressive treatment of patients with chronic pancreatitis and large-duct disease, we observed a small increase in weight and a small reduction in the number of opioid users. The changes may not be different from the natural course of the disease.
Medical Dept. 439, Gastrounit, Hvidovre University Hospital, Hvidovre, Denmark. drholm@ofir.dk
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Holm
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Matzen
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain
D000701:Analgesics, Opioid