scholarly journals Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy

Gut ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 402-405 ◽  
Author(s):  
H E Adamek ◽  
R Jakobs ◽  
A Buttmann ◽  
M U Adamek ◽  
A R J Schneider ◽  
...  
Keyword(s):  
Shock Wave ◽  
Chronic Pancreatitis ◽  
Clinical Outcome ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Statistical Significance ◽  
Treatment Success ◽  
Endoscopic Management ◽  
Endoscopic Drainage ◽  
Extracorporeal Shock Wave

BACKGROUNDThere have been conflicting reports as to whether pancreatic ductal drainage achieved by endoscopy and lithotripsy improves the clinical outcome of patients with chronic pancreatitis.AIMSTo determine the clinical outcome in patients with chronic pancreatitis who received extracorporeal shock wave lithotripsy (ESWL), and were followed up for two to eight years.METHODSEighty patients with severe chronic pancreatitis and endoscopically unretrievable obstructive stones underwent ESWL with a piezoelectric lithotripter between 1989 and 1996. Clinical status, relief of symptoms, further endoscopic or surgical interventions, and mortality were defined.RESULTSForty three (54%) patients were treated successfully with ESWL. The only feature associated with treatment success was the presence of a single stone rather than multiple stones. Successfully treated patients tended to experience less pain, although this did not reach statistical significance. A slight increase in weight was noted in our patients; however, there was no notable improvement in anomalous stools and diabetes mellitus. Five patients died due to extrapancreatic reasons. No pancreatic carcinomas developed.CONCLUSIONSESWL associated with endoscopic drainage is a safe technique that is particularly successful in patients with a single stone. However, pancreatic drainage by endoscopy and ESWL has almost no effect on pain in chronic pancreatitis. Furthermore, endoscopic management and ESWL does not prevent or postpone the development of glandular insufficiency.

Extracorporeal Shock Wave Lithotripsy (ESWL) and Endoscopic Management of Intrahepatic Lithiasis

2004 ◽  
Vol 59 (5) ◽  
pp. P196
Author(s):  
Gianluca Spera ◽  
Cristiano Spada ◽  
Massimiliano Mutignani ◽  
Vincenzo Perri ◽  
Andrea Tringali ◽  
...  
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Endoscopic Management ◽  
Extracorporeal Shock Wave ◽  
Intrahepatic Lithiasis

scholarly journals Preoperative use of alpha-1 receptor blockers in male patients undergoing extracorporeal shock wave lithotripsy for a ureteral calculus: a retrospective cohort study

2019 ◽  
Author(s):  
Takashi Yoshioka ◽  
Kenji Omae ◽  
Tatsushi Kawada ◽  
Yosuke Inoue ◽  
Morito Sugimoto ◽  
...  
Keyword(s):  
Shock Wave ◽  
Cohort Study ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Treatment Success ◽  
Ureteral Calculus ◽  
Single Session ◽  
Extracorporeal Shock Wave ◽  
Male Patients ◽  
Negative Predictor

Abstract Purpose To characterize the preoperative use of alpha-1 adrenergic receptor (AR) blockers and investigate its impact on the outcome of single-session extracorporeal shock wave lithotripsy (SWL) for a ureteral calculus in male patients. Methods We conducted a retrospective single-center cohort study involving 193 patients who underwent SWL for a single ureteral calculus between 2006 and 2016. We reviewed their medical records to obtain the data on the preoperative use of alpha-1 AR blocker and, if any, the reason for the prescription. The primary outcome was treatment success after single-session SWL, defined as complete stone clearance or residual fragments <4 mm in size by X-ray imaging. We performed a multivariable logistic regression analysis adjusting for clinically important confounders to examine the association between preoperative use of alpha-1 AR blockers and the treatment success of SWL. We further analyzed this association according to the reason for the prescription. Results Among the 193 patients, 15 (7.8%) were taking an alpha-1 AR blocker preoperatively with 8 (4.1%) for medical expulsive therapy (MET) and 7 (3.7%) for the treatment of benign prostatic hypertrophy (BPH). A multivariate analysis showed that the preoperative use of alpha-1 AR blocker was a significant negative predictor for treatment success of SWL (adjusted odds ratio [aOR] 0.17; 95% confidence intervals [CI], 0.04–0.74). Moreover, the use of alpha-1 AR blocker for MET, but not for BPH, was associated with lower rate of successful treatment (aOR 0.14 and 0.23; 95% CI, 0.02-0.90 and 0.03-1.97, respectively). Conclusions Our findings suggest that the preoperative use of alpha-1 AR blocker, especially for MET, was a negative predictor for treatment success of SWL in male patients with a single ureteral calculus. Clinicians should pay more attention to the preoperative drug use in determining an appropriate stone therapy modality.

scholarly journals Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE Trial): study protocol for a randomized sham-controlled trial

2020 ◽  
Author(s):  
Søren Schou Olesen ◽  
Asbjørn M. Drewes ◽  
Rajesh Goud Maragoni ◽  
Manu Tandan ◽  
Sundeep Lakhtakia ◽  
...  
Keyword(s):  
Shock Wave ◽  
Chronic Pancreatitis ◽  
Effective Treatment ◽  
Pancreatic Duct ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Endoscopic Treatment ◽  
Shock Wave Lithotripsy ◽  
Controlled Trial ◽  
Extracorporeal Shock Wave ◽  
Functional Scores

Abstract Background: Pain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) have been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clinical pain symptoms correlate poorly with pancreatic duct morphology and the evidence for pancreatic duct decompression as an effective treatment for pain is based on case-series and comparison between different procedures, while no randomised prospective sham-controlled trials are currently available. The SCHOKE trial is a randomized sham-controlled trial designed to determine if pancreatic duct decompression is an effective treatment for pain in patients with CP. Methods: The SCHOKE trial is a randomized, single-blinded, parallel-group, sham-controlled trial designed to evaluate the effect of combined ESWL and endoscopic treatment for pain in patients with CP. In total, 106 adult patients with painful CP and pancreatic duct obstruction will be randomized to combined ESWL and subsequent endoscopic treatment or corresponding sham procedures. The primary outcome is pain relief during the 3 months post-randomization period as documented in a pain diary. Secondary outcomes include quality of life and functional scores, patient’s global impression of change, change in use of analgesics, frequency of hospitalization and complications. Standard follow-up is at 3 and 6 months after randomization. In an experimental sub-study, quantitative sensory testing obtained before and after intervention will be used to obtain information on central pain processing and to develop models for prediction of treatment outcome. Discussion: The SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.

Sign in / Sign up

Export Citation Format

Share Document