title: Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts.
abstract: OBJECTIVE
  We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts (PPCs) in chronic pancreatitis (CP).
  
  
  METHODS
  This is a prospective study performed in CP patients with at least 1 stone (≥5 mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression.
  
  
  RESULTS
  A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPC group and the control group (11.86% vs 12.41%, P = .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P = .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life (P < .001), physical health (P < .001), and weight loss (P < .001) improved.
  
  
  CONCLUSIONS
  In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Department of Gastroenterology, Air Force General Hospital, Beijing, China.
authors.forename: Bai-Rong
authors.initials: BR
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Zhuan
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Du
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Ye
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Jun-Tao
authors.initials: JT
authors.lastname: Ji
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Zhao-Hong
authors.initials: ZH
authors.lastname: Zheng
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Hao
authors.affiliation: Department of Gastroenterology, Air Force General Hospital, Beijing, China.
authors.forename: Shou-Bin
authors.initials: SB
authors.lastname: Ning
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Jin-Huan
authors.initials: JH
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Liang-Hao
authors.initials: LH
authors.lastname: Hu
authors.affiliation: Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Zhao-Shen
authors.initials: ZS
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D002137:Calculi / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D019160:Endosonography; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008096:Lithotripsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010195:Pancreatitis / Q000453:epidemiology; D050500:Pancreatitis, Chronic / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult