Reply to Wang et al.

We appreciate the insights from Wang et al. [11]. We acknowledge the importance of stone size in determining the need for extracorporeal shockwave lithotripsy (ESWL). All patients included in our study had stone sizes greater than 5 mm, adhering to European Society of Gastrointestinal Endoscopy (ESGE) guidelines and similarly to our previously published work [22] [33]. We agree with the comment regarding the ESGE suggestion to restrict the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL. However, this recommendation is a weak recommendation [44]. In India, patients with chronic pancreatitis typically have large pancreatic stones, which are dense and spiculated. The practice of endoscopic therapy combined with ESWL is in alignment with published literature [33] [55].

Finally, we did not include the morphology of main pancreatic duct (MPD) stricture as a predictor of persistent pain in the current study; instead, we analyzed presence and absence of MPD stricture at the index procedure. We agree that the morphology of MPD stricture may influence pain. Out of 93 patients with MPD stricture, 14 patients had refractory MPD stricture in the current study.

Publication History

Article published online:
30 October 2024

• References

• 1 Wang J, Liu L, Fan Z. Comments on “Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis”. Endoscopy 2024; 56 DOI: 10.1055/a-2336-4274.
• 2 Gurav N, Jagtap N, Koppoju V. et al. Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis. Endoscopy 2024; 56: 406-411
• 3 Tandan M, Nageshwar Reddy D, Talukdar R. et al. ESWL for large pancreatic calculi: report of over 5000 patients. Pancreatology 2019; 19: 916-921
• 4 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
• 5 Talukdar R, Olesen SS, Unnisa M. et al. Extracorporeal shock-wave lithotripsy and endoscopy for the treatment of pain in chronic pancreatitis: a sham-controlled, randomized trial. Ann Intern Med 2024; DOI: 10.7326/M24-0210.