title: Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis.
abstract: BACKGROUND
  Most outcomes data on pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for chronic calcific pancreatitis (CCP) are based on studies with <4 years' follow-up, and U.S. long-term studies are lacking.
  
  
  OBJECTIVE
  To report long-term P-ESWL outcomes for CCP and to assess whether smoking or alcohol use influences P-ESWL outcomes.
  
  
  METHODS
  Cross-sectional study, retrospective chart review.
  
  
  METHODS
  Virginia Mason Medical Center, Seattle, Washington.
  
  
  METHODS
  This study involved 120 patients who underwent P-ESWL and ERCP for CCP and completed an outcomes questionnaire.
  
  
  METHODS
  P-ESWL and ERCP, outcomes survey.
  
  
  METHODS
  Pain, quality of life, narcotics use, diabetes status, pancreatic enzyme requirement, repeat P-ESWL, repeat ERCP, surgery.
  
  
  RESULTS
  A total of 120 patients underwent P-ESWL followed by ERCP (mean ± standard deviation [SD] follow-up 4.3 [± 3.7] years) and completed a survey. The mean (± SD) before-P-ESWL pain score was 7.9 (± 2.6) compared with 2.9 (± 2.6) after P-ESWL (P < .001). Improved pain was reported by 102 patients (85%); 60 (50%) reported complete pain relief and no narcotic use. The mean (± SD) before-P-ESWL quality-of-life score was 3.7 (± 2.4) compared with 7.3 (± 2.7) after P-ESWL (P < .001). In patients with ≥ 4 years' follow-up, repeat procedures included P-ESWL (29%), ERCP (84%), and surgery (16%). Smokers who quit smoking after P-ESWL had improved narcotic requirements compared with those who continued smoking (95% vs 67%; P = .014), and a trend suggested a decreased need for repeat ERCPs (68% vs 84%; P = .071).
  
  
  CONCLUSIONS
  Single center, retrospective, recall bias, nonvalidated pain and quality-of-life scales.
  
  
  CONCLUSIONS
  P-ESWL as the initial therapy for CCP may lead to more lifetime procedures; however, partial pain relief in 85%, complete pain relief with no narcotic use in 50%, and avoidance of surgery in 84% of patients may be achieved. Quitting smoking after P-ESWL may improve outcomes.
authors.affiliation: The Digestive Disease Institute at Virginia Mason, Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Gulseren
authors.initials: G
authors.lastname: Seven
authors.forename: Mitchal A
authors.initials: MA
authors.lastname: Schreiner
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Ross
authors.forename: Otto S
authors.initials: OS
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
authors.forename: S Ian
authors.initials: SI
authors.lastname: Gan
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.forename: John J
authors.initials: JJ
authors.lastname: Brandabur
authors.forename: David
authors.initials: D
authors.lastname: Patterson
authors.forename: Christian
authors.initials: C
authors.lastname: Kuhr
authors.forename: Richard
authors.initials: R
authors.lastname: Kozarek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D002137:Calculi / Q000150:complications / Q000628:therapy*; D016009:Chi-Square Distribution; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D050500:Pancreatitis, Chronic / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics