title: Effectiveness of oral litholysis therapy for improving glucose intolerance and malnutrition in patients with poor results following endoscopic therapy and extracorporeal shock wave lithotripsy for calcified pancreatic stones.
abstract: We report a case of pancreatolithiasis in which glucose intolerance and malnutrition were significantly improved after starting oral litholysis therapy (OLT) with use of trimethadione. A 43-year-old female with multiple calcified stones in the main and peripheral pancreatic ducts had experienced recurrent and severe attacks of pain for 7 years (from 21 to28 years of age). Impaired glucose tolerance was first noted at the age of 32 years. We started OLT after interventional endoscopic therapy combined with extracorporeal shock wave lithotripsy failed because of kink and stenosis of the main pancreatic duct (MPD). Over the next 9 years, a significant decrease in total pancreatic calcified stone volume was shown by computer analysis of follow-up computed tomography images. Larger stones completely disappeared without attacks of pain. In addition, both glucose intolerance and insulin secretion were significantly ameliorated, followed by improvement of malnutrition. OLT may induce intraductal decompression by dissolving stones in the peripheral ducts as well as the MPD, with resulting preservation of endocrine function and improvement of malnutrition. Since the present results were obtained in a single case, further clinical trials are necessary to evaluate the value of performing OLT under various conditions to eliminate stones.
authors.affiliation: Division of Gastroenterology, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Yumachi 1-2, Matsue, 699-0293, Japan. ashizawa.n@smn.enjoy.ne.jp.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ashizawa
authors.affiliation: Division of General Medicine, Aichi Medical University Hospital, Karimata, Yazako, Nagakute-cho, Aichi-gun, Aichi, 480-1195, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hamano
authors.affiliation: Division of Internal Medicine, Aichi Medical University Medical Clinic, Higashi-ku, Higashisakura 2-12-1, Nagoya, 461-0005, Japan.
authors.forename: Aiji
authors.initials: A
authors.lastname: Noda
mesh_terms: D000328:Adult; D002137:Calculi / Q000150:complications* / Q000188:drug therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D018149:Glucose Intolerance / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007328:Insulin / Q000097:blood; D008096:Lithotripsy; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications* / Q000188:drug therapy*; D014293:Trimethadione / Q000627:therapeutic use*
chemical_list: D007328:Insulin; D014293:Trimethadione
keywords: Chronic calcific pancreatitis; Impaired glucose tolerance; Oral litholysis therapy; Pancreatic stones; Trimethadione