Abstract
Background/Aims
A retrospective analysis was performed to evaluate the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) for pancreatolithiasis on successive days under intravenous bolus of pethidine alone.
Methods
Ninety patients with calcified pancreatic stones (≥5 mm) presenting with abdominal pain were selected for ESWL. ESWL was performed with an electroconductive lithotripter under fluoroscopic target systems. Fragmented calculi after ESWL were removed by endotherapy.
Results
A mean of 4.2 ESWL sessions were performed for each patient, with a mean of 2,984 shocks at a mean power setting of 12.8 kV. Eighty-four (89.3%) patients underwent ESWL for three or more days in a row. Fragmentation of the stones were achieved in 83/90 (92.2%) patients. Complete clearance of the main pancreatic duct was achieved in 54/90 (60.0%) patients, and partial clearance was achieved in 27 (30.0%) patients. The mean dose of pethidine used during ESWL was 53.5±20.7 mg per session. As ESWLrelated complications, four (4.3%) patients developed mild acute pancreatitis.
References
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Table 1.
Table 2.
Data | |
---|---|
ESWL | |
Shock wave number | 2,984 (2,500–5,000) |
Shock wave energy (kV) | 12.8 (11.0–13.5) |
Session number per patient | 4.2 (1–9) |
Analgesic use (pethidine) | 53.5±20.7 |
One injection (50 mg) | 358 |
Two injection (100 mg) | 27 |
Pain score (NRS) during ESWLa | |
One injection (50 mg) | 1.96±1.76 |
Two injection (100 mg) | 2.92±1.92 |
ERCP | |
Pre-ESWL pancreatic sphincterotomy | 59 (65.5) |
Post-ESWL ERCP with therapeutic intent | 90 (100) |
ERCP session for stone removal | 2.0 (1–4) |
Use of Soehendra stent | 63 (70.0) |
Pancreatic stenting | 65 (72.2) |
Endoscopic nasopancreatic drainage | 9 (10.0) |
Table 3.
Acute pancreatitis | |
---|---|
Per one patient | 4/90 (4.4) |
Per one ESWL session | 4/385 (1.0) |
Skin redness and ecchymosis | 2/90 (2.2) |
Table 4.
Variable | Data |
---|---|
Fragmentation of stone with ESWL | 83 (92.2) |
Clearance of pancreatic duct stone | |
Complete | 54 (60.0) |
Partial | 27 (30.0) |
Failed | 9 (10.0) |
Change of main pancreatic duct diametera (mm) | |
Pre-treatment | 7.7±3.0 |
Post-treatment | 4.4±2.9 |
Pain scorea (NRS) | |
Before ESWL | 5.9±1.5 |
On follow-up after ESWL/ERCP | 0.5±0.7 |
Pain recurrence during follow-up | 15 (16.7) |
Surgery | 5 (5.6) |
Table 5.
Study | Year | Patient (n) | Stone size (mm) | Shock wave energy source | Shock wave number per session | Anesthesia method | Fragmentation (%) | Complete clearance rate (%) | Need for surgery (%) | Mean follow up (mo) | Complication rates (%) |
---|---|---|---|---|---|---|---|---|---|---|---|
Delhaye et al.10 | 1992 | 123 | 7.8–13.2 | Electromagnetic | 2,862 | Diazepam, pethidine | 99 | 59 | 5 | 14 | ND |
Inui et al.9 | 2005 | 425 | 10–20 | Electrohydraulic, etc.a | 2,407–5,191 | ND | 92 | 73 | 4 | 44 | 6.3 |
Sasahira et al.24 | 2007 | 40 | 4–20 | Electromagnetic | ND | Pethidine | ND | 88 | ND | 18 | 15 |
Dumonceau et al.11 | 2007 | 55 | 3.5–26 | Electromagnetic | ND | ND | ND | ND | 4 | 52 | 1.8 |
Tandan et al.12 | 2010 | 1,006 | >5 | Electromagnetic | 5,400–10,200 | EA | ND | 76 | 3.7 | 6 | 33.5 |
Lawrence et al.21 | 2010 | 25 | 8–25 | Electromagnetic | 4,863 | GA | 60 | 59 | 32 | 35 | 6.9 |
Seven et al.25 | 2012 | 120 | 5–10 | Electromagnetic | 2,312 | GA | ND | ND | 16 | 51 | ND |
Present study | 2013 | 90 | 5–20 | Electroconductiveb | 2,984 | Pethidine | 92 | 60 | 5.3 | 20 | 6.7 |