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Endoscopy 2024; 56(06): 406-411
DOI: 10.1055/a-2252-9920
Original article

Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis

Nitish Gurav
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Nitin Jagtap 
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Vinod Koppoju
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Kiran Sekhramantri
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Shujaath Asif 
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Manu Tandan
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Sundeep Lakhtakia 
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Rakesh Kalapala
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Mohan Ramchandani
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Rupjyoti Talukdar
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Jahangeer Basha 
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Zaheer Nabi 
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Sana Fatima Memon
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
Santosh Darisetty
2   Department of Gastrointestinal Anaesthesia, AIG Hospitals, Hyderabad, India
,
Guduru Venkat Rao
3   Department of Surgical Gastroenterology, AIG Hospitals, Hyderabad, India
,
D. Nageshwar Reddy
1   Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT04490083, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective
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Abstract

Background Extracorporeal shockwave lithotripsy (ESWL) and/or endoscopic retrograde cholangiopancreatography (ERCP) are recommended as first-line therapy for painful uncomplicated chronic pancreatitis with obstructed main pancreatic duct (MPD) in the pancreas head/body. However, predictors of pain relief after ESWL are unknown. We evaluated independent predictors of persistent pain in patients who underwent ESWL for chronic pancreatitis.

Methods 640 consecutive adult patients with chronic pancreatitis, who underwent successful ESWL with ERCP and pancreatic duct (PD) stent placement, were followed for 12 months. The pain was assessed at baseline and at 12 months using the Izbicki Pain Score, with a score decrease of >50% considered pain relief. Independent predictors of pain relief were derived from logistic regression analysis.

Results Of 640 patients (mean age 36.71 [SD 12.19] years; 60.5% men), 436 (68.1%) had pain relief and 204 (31.9%) had persistent pain. On univariate analysis, older age, male sex, alcohol and tobacco intake, longer duration of symptoms, dilated MPD and MPD stricture were associated with persistent pain at 12 months (P<0.05). Consumption of alcohol (odds ratio [OR] 1.93, 95%CI 1.26–2.97), tobacco (OR 4.09, 95%CI 2.43–6.90), duration of symptoms (OR 1.02, 95%CI 1.01–1.04), MPD size (OR 1.22, 95%CI 1.11–1.33), and MPD stricture (OR 8.50, 95%CI 5.01–14.42) were independent predictors of persistent pain.

Conclusions Alcohol, tobacco, duration of symptoms, MPD size and stricture were independent predictors of persistent pain after successful ESWL. A multidisciplinary team approach that includes behavioral therapy and surgical options should be considered for such patients.

Supplementary Material



Publication History

Received: 16 August 2023

Accepted after revision: 24 January 2024

Accepted Manuscript online:
24 January 2024

Article published online:
21 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Comments on “Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis”Endoscopy 2024; 56(09): 719-720
DOI: 10.1055/a-2307-6320

Letter to this article:

Comments on “Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis”Endoscopy 2024; 56(11): 888-888
DOI: 10.1055/a-2336-4274

Letter to this article:

The necessity of therapeutic ERCP after extracorporeal shockwave lithotripsy in chronic calcific pancreatitisEndoscopy 2025; 57(02): 191-191
DOI: 10.1055/a-2399-3175

 

  • References

  • 1 Tandan M, Nageshwar Reddy D, Talukdar R. et al. ESWL for large pancreatic calculi: report of over 5000 patients. Pancreatology 2019; 19: 916-921
    CrossrefPubMedSearch in Google Scholar
  • 2 Pasricha PJ. Unraveling the mystery of pain in chronic pancreatitis. Nat Rev Gastroenterol Hepatol 2012; 9: 140-151
    CrossrefPubMedSearch in Google Scholar
  • 3 Mullady DK, Yadav D, Amann ST. et al. Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Gut 2011; 60: 77-84
    CrossrefPubMedSearch in Google Scholar
  • 4 Romagnuolo J, Talluri J, Kennard E. et al. Clinical profile, etiology, and treatment of chronic pancreatitis in North American women: analysis of a large multicenter cohort. Pancreas 2016; 45: 934-940
    CrossrefPubMedSearch in Google Scholar
  • 5 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – updated August 2018. Endoscopy 2019; 51: 179-193
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Hu LH, Ye B, Yang YG. et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones: a prospective study of 214 cases. Pancreas 2016; 45: 298-305
    CrossrefPubMedSearch in Google Scholar
  • 7 Ohyama H, Mikata R, Ishihara T. et al. Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones. Pancreas 2015; 44: 422-428
    CrossrefPubMedSearch in Google Scholar
  • 8 Seven G, Schreiner MA, Ross AS. et al. Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2012; 75: 997-1004.e1001
    CrossrefPubMedSearch in Google Scholar
  • 9 Dumonceau JM, Costamagna G, Tringali A. et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut 2007; 56: 545-552
    CrossrefPubMedSearch in Google Scholar
  • 10 Tadenuma H, Ishihara T, Yamaguchi T. et al. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol 2005; 3: 1128-1135
    CrossrefPubMedSearch in Google Scholar
  • 11 Farnbacher MJ, Muhldorfer S, Wehler M. et al. Interventional endoscopic therapy in chronic pancreatitis including temporary stenting: a definitive treatment?. Scand J Gastroenterol 2006; 41: 111-117
    CrossrefPubMedSearch in Google Scholar
  • 12 Ponchon T, Bory RM, Hedelius F. et al. Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol. Gastrointest Endosc 1995; 42: 452-456
    CrossrefPubMedSearch in Google Scholar
  • 13 Tandan M, Talukdar R, Reddy DN. Management of pancreatic calculi: an update. Gut Liver 2016; 10: 873-880
    CrossrefPubMedSearch in Google Scholar
  • 14 Tandan M, Pal P, Reddy DN. Management of pancreatic duct stones: extracorporeal approach. Gastrointest Endosc Clin N Am 2023; 33: 807-820
    CrossrefPubMedSearch in Google Scholar
  • 15 Delhaye M, Arvanitakis M, Verset G. et al. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol 2004; 2: 1096-1106
    CrossrefPubMedSearch in Google Scholar
  • 16 Dumonceau JM, Deviere J, Le Moine O. et al. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results. Gastrointest Endosc 1996; 43: 547-555
    CrossrefPubMedSearch in Google Scholar
  • 17 Tantau A, Mandrutiu A, Leucuta DC. et al. Prognostic factors of response to endoscopic treatment in painful chronic pancreatitis. World J Gastroenterol 2017; 23: 6884-6893
    CrossrefPubMedSearch in Google Scholar
  • 18 Topazian M, Aslanian H, Andersen D. Outcome following endoscopic stenting of pancreatic duct strictures in chronic pancreatitis. J Clin Gastroenterol 2005; 39: 908-911
    CrossrefPubMedSearch in Google Scholar
  • 19 Papalavrentios L, Musala C, Gkolfakis P. et al. Multiple stents are not superior to single stent insertion for pain relief in patients with chronic pancreatitis: a retrospective comparative study. Endosc Int Open 2019; 7: E1595-E1604
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Farnbacher MJ, Schoen C, Rabenstein T. et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success. Gastrointest Endosc 2002; 56: 501-506
    CrossrefPubMedSearch in Google Scholar
  • 21 Thomas M, Howell DA, Carr-Locke D. et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol 2007; 102: 1896-1902
    CrossrefPubMedSearch in Google Scholar
  • 22 Vaysse T, Boytchev I, Antoni G. et al. Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis. Scand J Gastroenterol 2016; 51: 1380-1385
    CrossrefPubMedSearch in Google Scholar