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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E274-E281
DOI: 10.1055/a-2226-1464
Original article

Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy

Ankit Dalal 
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Nagesh Kamat 
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Amit Maydeo 
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Gaurav Patil
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Amol Vadgaonkar
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Sanil Parekh
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Sehajad Vora
1   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
› Author Affiliations Clinical Trial: Registration number (trial ID): CTRI/2019/06/019750, Trial registry: Clinical Trials Registry India (http://www.ctri.nic.in/Clinicaltrials), Type of Study: Prospective observational study
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Abstract

Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored.

Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point.

Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29–55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7–1260.7) and the number of ESWL sessions was 2 (range, 2–3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P<0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%.

Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.

Keywords

Stones - Pancreatobiliary (ERCP/PTCD) - Strictures

Supplementary Material



Publication History

Received: 26 September 2023

Accepted after revision: 05 December 2023

Accepted Manuscript online:
11 December 2023

Article published online:
28 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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