Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Pancreatology. 2024 Jun;24(4):643-648. doi: 10.1016/j.pan.2024.03.018. Epub 2024 Mar 28.
BACKGROUND & AIM: Extracorporeal shock wave lithotripsy (ESWL) is used for the treatment of pancreatic duct stones (PDS) in patients with chronic pancreatitis (CP). We aimed to develop a CT based index to predict the required number of ESWL sessions for technical success.
We retrospectively evaluated patients with PDS secondary to CP who underwent ESWL. Technical success was defined as the complete fragmentation of stones to <3 mm. CT features including PDS size, number, location, and density in Hounsfield units (HU) were noted. We analyzed the relationship between PDS characteristics and the number of ESWL sessions required for technical success. A multiple linear regression model was used to combine size and density into the pancreatic duct stone (PDS) index that was translated into a web-based calculator.
There were 206 subjects (mean age 38.6 ± 13.7 years, 59.2% male) who underwent ESWL. PDS size showed a moderate correlation with the number of ESWL sessions (r = 0.42, p < 0.01). PDS in the head required a fewer number of sessions in comparison to those in the body (1.4 ± 0.6 vs. 1.6 ± 0.7, p = 0.01). There was a strong correlation between PDS density and the number of ESWL sessions (r = 0.617, p-value <0.01). The PDS index {0.3793 + [0.0009755 x PDS density (HU)] + [0.02549 x PDS size (mm)]} could accurately predict the required number of ESWL sessions with an AUC of 0.872 (p < 0.01).
The PDS index is a useful predictor of the number of ESWL sessions needed for technical success that can help in planning and patient counseling.
体外冲击波碎石术（ESWL）用于治疗慢性胰腺炎（CP）患者的胰管结石（PDS）。我们旨在开发一种基于 CT 的指数来预测技术成功所需的 ESWL 次数。
我们回顾性评估了因 CP 而接受 ESWL 的 PDS 患者。技术成功定义为结石完全碎裂至 <3mm。记录了 CT 特征，包括 PDS 的大小、数量、位置和在亨氏单位（HU）中的密度。我们分析了 PDS 特征与技术成功所需的 ESWL 次数之间的关系。使用多元线性回归模型将大小和密度合并到胰管结石（PDS）指数中，并将其转换为基于网络的计算器。
共有 206 名患者（平均年龄 38.6±13.7 岁，59.2%为男性）接受了 ESWL。PDS 大小与 ESWL 次数呈中度相关（r=0.42，p<0.01）。与体部相比，头部的 PDS 需要更少的 ESWL 次数（1.4±0.6 次与 1.6±0.7 次，p=0.01）。PDS 密度与 ESWL 次数呈强相关（r=0.617，p 值<0.01）。PDS 指数 {0.3793+[0.0009755 x PDS 密度（HU）]+[0.02549 x PDS 大小（mm）]} 可以准确预测 ESWL 次数，AUC 为 0.872（p<0.01）。
PDS 指数是预测技术成功所需 ESWL 次数的有用指标，有助于计划和患者咨询。
