ERCP and ESWL for Pancreatic Duct Stones

[Guest guest]

ERCP and ESWL for Pancreatic Duct Stones

Despite initial promising results, recent publications have raised doubts

regarding Extracorporal Shock Wave Lithotripsy (ESWL) fragmentation and

Endoscopic Retrograde Cholangiopancreatography (ERCP) removal of Pancreatic Duct

(PD) stones with regards to long-term outcomes. We reviewed our results in the

subset of patients with PD stones requiring ESWL prior to stone retrieval.

Materials/Methods:

40 patients undergoing PD ESWL between 1/95 & 5/2000 were retrospectively

reviewed. Data collected included:

a.. Presentation

b.. ESWL sessions number & efficacy

c.. Outcomes to include: pre & post procedural pain score (0-10), narcotic

use, yearly pancreatitis-related hospitalizations, and need for surgery.

Results:

a.. 40 patients (21 males, 19 females; mean age 53 years) underwent 46 ESWL &

89 ERCP sessions.

b.. Presentations included Chronic Recurrent Pancreatitis (CRP) 13, chronic

pain 8, both 15, and weight loss/steatorrhea (fatty loose stools) 4.

c.. Stone etiology was: alcohol 23, idiopathic 9, familial 3, and other 5.

d.. 11/40 patients had single calculi (stones) and 29/40 had multiple stones.

e.. Additional pathology included: PD stricture 19, PD leak/pseudocyst 7/9,

and other 3.

f.. All patients had pre-ESWL PD Endoscopic Sphincterotomy (ES) and 23 PD

stent/drain placement prior to ESWL

g.. Dornier HM3 lithotripor was used (mean shocks/session 2,142 +/- 149, mean

energy 21.6 +/- 0.5 Kv).

h.. There was no mortality.

i.. Complications included: pancreatitis flare 1, sepsis 1, and

gastrointestinal bleeding 1.

j.. At a mean followup of 2.4 +/- 0.6 years (0.3 - 5.4 years), 4 patients died

of non-pancreatitis related causes and 8 had eventual pancreaticobiliary

surgery.

k.. Of the remaining 28 patients, there was significant difference in pre and

post ESWL pain, yearly pancreatitis-related admissions, and narcotics use.

l.. Pain score dropped from 6.9 to 2.4 p=0.0001

m.. Pancreatitis related yearly admissions dropped from 3.4 to 0.9 p=0.0001

n.. Oxycodone-equivalent narcotics usage/month dropped from 125 tablets to 80

p=0.03

o.. Results were comparable to surgically treated patients.

Conclusions:

a.. At a mean followup of 2.4 years, 80% of patients undergoing ERCP-ESWL

avoided need for surgery and had significantly: fewer hospitalizations, less

pain, and reduced narcotic use.

b.. ERCP-ESWL should be considered as first-line therapy in symptomatic

patients with obstructing PD stones not amenable to endoscopic removal alone.

[Guest guest]

The conclusion of that study stated, " At a mean followup of 2.4 years,

80% of patients undergoing ERCP-ESWL avoided need for surgery and had

significantly: fewer hospitalizations, less pain, and reduced narcotic

use. "

I think 80% is quite impressive. *It is interesting that we do not

hear about many erpsons undergoing the ERCP-ESWL very often. Thank you

for finding that abstract.

Karyn , RN

Executive Director, PAI