title: Extracorporeal shock wave lithotripsy treatment of pancreatic stones complicated with advanced stage autoimmune pancreatitis.
abstract: BACKGROUND
  Although most patients with autoimmune pancreatitis (AIP) respond favorably to prednisolone therapy, some individuals who later suffer from pancreatic calculi may require additional extracorporeal shock wave lithotripsy (ESWL) treatment. This study compares the efficacy of ESWL for calculi in AIP with that in ordinary chronic pancreatitis (CP) and proposes a new treatment approach for pancreatic duct stones occurring in AIP.
  
  
  METHODS
  We examined the clinical records of 8 patients with chronic stage AIP and 92 patients with ordinary CP who received ESWL for pancreatic calculi.
  
  
  RESULTS
  The AIP group was significantly older than the CP group (69.0 vs. 56.5 years, P = 0.018). With regard to the indications for ESWL, chronic pain was significantly less frequent in the chronic stage AIP group (0% vs. 45.7%, P = 0.001), whereas preservation of pancreatic function was significantly more frequent (75% vs. 19.6%, P = 0.001). Compared with the CP group, the AIP group tended to exhibit pancreatic duct stenosis proximal to pancreatic calculi and had a lower rate of complete extraction of stones from the main pancreatic duct. Histopathological analysis of a patient with chronic stage AIP revealed widely distributed nodular pancreatitis, which was characteristic of ordinary CP, along with isolated areas of lymphoplasmacytic sclerosing pancreatitis.
  
  
  CONCLUSIONS
  Different approaches are needed for the treatment of pancreatic calculi in chronic stage AIP and ordinary CP. Specifically, it appears that intensive ESWL therapy can be avoided or delayed in AIP if the patient displays: (1) advanced age, (2) little or no chronic pain or pancreatitis, and (3) pancreatic duct stenosis proximal to pancreatic stones. In such cases, the benefit of ESWL treatment may be outweighed by the risks involved in this procedure.
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. masa10_hiro15@yahoo.co.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Maruyama
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. wat1400@shinshu-u.ac.jp.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. drunkenstein3@gmail.com.
authors.forename: Keita
authors.initials: K
authors.lastname: Kanai
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. ogu0726@shinshu-u.ac.jp.
authors.forename: Takaya
authors.initials: T
authors.lastname: Oguchi
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. 13mh002j@shinshu-u.ac.jp.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Asano
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. itotetsu@shinshu-u.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. muraki@shinshu-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muraki
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. hidehama@shinshu-u.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Hamano
authors.affiliation: Endoscopic Examination Center, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. arakuran@shinshu-u.ac.jp.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Arakura
authors.affiliation: Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. tuehara@shinshu-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uehara
authors.affiliation: Center for Health, Safety, and Environmental Management, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. skawapc@shinshu-u.ac.jp.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications* / Q000473:pathology; D002137:Calculi / Q000150:complications / Q000628:therapy*; D059350:Chronic Pain / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000628:therapy*; D010183:Pancreatic Ducts / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult