Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis

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• 作者：Gulseren Seven ; MD¹ ; Mitchal A. Schreiner ; MD ; MPH¹ ; Andrew S. Ross ; MD¹ ; Otto S. Lin ; MD¹ ; Michael Gluck ; MD¹ ; S. Ian Gan ; MD¹ ; Shayan Irani ; MD¹ ; John J. Brandabur ; MD¹ ; David Patterson ; MD¹ ; Christian Kuhr ; MD² ; Richard Kozarek ; MD¹ ;
• 关键词：CCP ; chronic calcific pancreatitis ; P-ESWL ; pancreatic extracorporeal shock wave lithotripsy ; PD ; pancreatic duct
• 刊名：Gastrointestinal Endoscopy
• 出版年：2012
• 期刊代码：130_00165107
• 类别：med
• 出版时间：May, 2012
• 卷：75
• 期：5
• 页码：997-1004.e1
• 文件大小：619 K

摘要

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Background

Most outcomes data on pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for chronic calcific pancreatitis (CCP) are based on studies with <4 years' follow-up, and U.S. long-term studies are lacking.

Objective

To report long-term P-ESWL outcomes for CCP and to assess whether smoking or alcohol use influences P-ESWL outcomes.

Design

Cross-sectional study, retrospective chart review.

Setting

Virginia Mason Medical Center, Seattle, Washington.

Patients

This study involved 120 patients who underwent P-ESWL and ERCP for CCP and completed an outcomes questionnaire.

Intervention

P-ESWL and ERCP, outcomes survey.

Main Outcome Measurements

Pain, quality of life, narcotics use, diabetes status, pancreatic enzyme requirement, repeat P-ESWL, repeat ERCP, surgery.

Results

A total of 120 patients underwent P-ESWL followed by ERCP (mean 卤 standard deviation [SD] follow-up 4.3 [卤 3.7] years) and completed a survey. The mean (卤 SD) before-P-ESWL pain score was 7.9 (卤 2.6) compared with 2.9 (卤 2.6) after P-ESWL (P < .001). Improved pain was reported by 102 patients (85%); 60 (50%) reported complete pain relief and no narcotic use. The mean (卤 SD) before-P-ESWL quality-of-life score was 3.7 (卤 2.4) compared with 7.3 (卤 2.7) after P-ESWL (P < .001). In patients with 鈮? years' follow-up, repeat procedures included P-ESWL (29%), ERCP (84%), and surgery (16%). Smokers who quit smoking after P-ESWL had improved narcotic requirements compared with those who continued smoking (95%vs 67%; P = .014), and a trend suggested a decreased need for repeat ERCPs (68%vs 84%; P = .071).

Limitations

Single center, retrospective, recall bias, nonvalidated pain and quality-of-life scales.

Conclusion

P-ESWL as the initial therapy for CCP may lead to more lifetime procedures; however, partial pain relief in 85%, complete pain relief with no narcotic use in 50%, and avoidance of surgery in 84%of patients may be achieved. Quitting smoking after P-ESWL may improve outcomes.