title: Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial.
abstract: BACKGROUND
  In chronic pancreatitis, obstruction of the main pancreatic duct (MPD) may contribute to the pathogenesis of pain. Pilot studies suggest that extracorporeal shock wave lithotripsy (ESWL) alone relieves pain in calcified chronic pancreatitis.
  
  
  OBJECTIVE
  To compare ESWL alone with ESWL and endoscopic drainage of the MPD for treatment of pain in chronic pancreatitis.
  
  
  METHODS
  Patients with uncomplicated painful chronic pancreatitis and calcifications obstructing the MPD.
  
  
  METHODS
  55 patients were randomised to ESWL alone (n = 26) or ESWL combined with endoscopy (n = 29).
  
  
  RESULTS
  2 years after trial intervention, 10 (38%) and 13 (45%) patients of the ESWL alone and ESWL combined with endoscopy group, respectively, had presented pain relapse (primary outcome) (OR 0.77; 95% CI 0.23 to 2.57). In both groups, a similar decrease was seen after treatment in the MPD diameter (mean decrease 1.7 mm; 95% CI 0.9 to 2.6; p<0.001), and in the number of pain episodes/year (mean decrease, 3.7; 95% CI 2.6 to 4.9; p<0.001). Treatment costs per patient were three times higher in the ESWL combined with endoscopy group compared with the ESWL alone group (p = 0.001). The median delay between the onset of chronic pancreatitis and persistent pain relief for both groups was 1.1 year (95% CI 0.7 to 1.6), as compared with 4 years (95% CI 3 to 4) for the natural history of chronic pancreatitis in a reference cohort (p<0.001).
  
  
  CONCLUSIONS
  ESWL is a safe and effective preferred treatment for selected patients with painful calcified chronic pancreatitis. Combining systematic endoscopy with ESWL adds to the cost of patient care, without improving the outcome of pancreatic pain.
authors.affiliation: Department of Gastroenterology, Erasmus University Hospital, Brussels, Belgium. jmdumonceau@hotmail.com
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Andrea
authors.initials: A
authors.lastname: Tringali
authors.forename: Kouroche
authors.initials: K
authors.lastname: Vahedi
authors.forename: Myriam
authors.initials: M
authors.lastname: Delhaye
authors.forename: Axel
authors.initials: A
authors.lastname: Hittelet
authors.forename: Gianluca
authors.initials: G
authors.lastname: Spera
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.forename: Viviane
authors.initials: V
authors.lastname: De Maertelaer
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D002114:Calcinosis / Q000150:complications / Q000191:economics / Q000628:therapy; D002137:Calculi / Q000150:complications / Q000191:economics / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008096:Lithotripsy / Q000191:economics; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications / Q000191:economics / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome