Asian Institute of Gastroenterology, Hyderabad, India.
Asian Institute of Gastroenterology, Hyderabad, India.
Pancreatology. 2019 Oct;19(7):916-921. doi: 10.1016/j.pan.2019.08.001. Epub 2019 Aug 2.
The primary aim of this study was to evaluate efficacy, safety and short-term pain relief after ESWL for large pancreatic calculi in over 5000 patients at a single center.
This is a retrospective analysis of prospectively collected data. Patients with painful calculi >5 mm, located in the head, neck and body region in the MPD, who were not amenable for extraction by the standard procedure of endoscopic pancreatic sphincterotomy were subjected to ESWL using a third generation dual focus lithotripter. Patients were followed up at 6 months for outcome evaluation.
A total of 5124 patients (66% males) were subjected to ESWL. Majority of stones (79.2%) were radiopaque. Single calculi were seen in 3851 (75.1%).The majority of stones were located in head region of MPD in 2824 (55.1%) patients. 4386 (85.5%) patients required 3 or less sessions for fragmentation and complete stone clearance was achieved in 3722 (72.6%). EPS was performed in 5022 (98%) while PD stenting was required in 3536 (69%) patients. Of the 4280 patients followed up for 6 months, 3529 (82.6%) patients were pain free. Another 512 (11.9%) patients had significant reduction in VAS score. In 229 (5.3%) there was no decrease in pain intensity. Minor and self-limiting complications were reported in 1153 (22.5%).
Our study confirms the safety and efficacy and short-term pain relief of ESWL for large calculi in the MPD. In properly selected patients, this should be offered as the first line of therapy for all large MPD calculi not amenable to the standard techniques of stone extraction.
本研究的主要目的是评估在单一中心对超过 5000 例大胰管结石患者进行体外冲击波碎石术（ESWL）的疗效、安全性和短期疼痛缓解。
这是一项对前瞻性收集数据进行的回顾性分析。对因标准内镜胰管括约肌切开术不适合取出而位于胰头部、颈部和体部的>5mm 疼痛性结石的患者，采用第三代双焦点碎石机进行 ESWL。患者在 6 个月时进行随访以评估结果。
共有 5124 例（66%为男性）患者接受了 ESWL。大多数结石（79.2%）为不透射线。3851 例（75.1%）患者为单发结石。2824 例（55.1%）患者的大多数结石位于胰头部。4386 例（85.5%）患者需要 3 次或更少的碎石次数，3722 例（72.6%）患者完全清除结石。5022 例（98%）患者进行了胰管括约肌切开术，3536 例（69%）患者需要胰管支架置入。在 4280 例随访 6 个月的患者中，3529 例（82.6%）患者疼痛消失。另有 512 例（11.9%）患者 VAS 评分显著降低。229 例（5.3%）患者疼痛强度无下降。1153 例（22.5%）患者出现轻微且自限性并发症。
本研究证实了 ESWL 治疗大胰管结石的安全性、有效性和短期疼痛缓解。在适当选择的患者中，对于所有不适合标准结石取出技术的大胰管结石，应将其作为一线治疗方法。
