Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy

Bai-Rong Li; Zhuan Liao; Ting-Ting Du; Bo Ye; Wen-Bin Zou; Hui Chen; Jun-Tao Ji; Zhao-Hong Zheng; Jun-Feng Hao; Ying-Yi Jiang; Liang-Hao Hu; Zhao-Shen Li

doi:10.1055/s-0034-1377753

Endoscopy, Table of Contents

Endoscopy 2014; 46(12): 1092-1100
DOI: 10.1055/s-0034-1377753

Original article

Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy

Bai-Rong Li^*

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Zhuan Liao^*

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Ting-Ting Du^*

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Bo Ye

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Wen-Bin Zou

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Hui Chen

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Jun-Tao Ji

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Zhao-Hong Zheng

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Jun-Feng Hao

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Ying-Yi Jiang

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Liang-Hao Hu

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Zhao-Shen Li

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China

› Author Affiliations

Abstract

Background and study aims: Extracorporeal shock wave lithotripsy is recommended as treatment for stones in chronic pancreatitis. The aim of this study was to investigate the risk factors for complications of pancreatic extracorporeal shock wave lithotripsy (P-ESWL).

Patients and methods: Patients with painful chronic pancreatitis and pancreatic stones (> 5 mm diameter) who were treated with P-ESWL between March 2011 and June 2013 were prospectively included. Adverse events after P-ESWL were classified as complications and transient adverse events, depending on severity. The major complications of P-ESWL included post-ESWL pancreatitis, bleeding, infection, steinstrasse, and perforation. Multivariate analyses based on univariate analysis were performed to detect risk factors of overall and moderate-to-severe complications.

Results: A total of 634 patients underwent 1470 P-ESWL procedures. The overall complication rate was 6.7 % of all procedures. Complications occurred in 62 patients (9.8 %) after the first ESWL procedure. The risk factors for complications were pancreas divisum (odds ratio [OR] 1.28) and the interval between diagnosis of chronic pancreatitis and P-ESWL (OR 1.28). Protective factors were male sex (OR 0.50), diabetes (OR 0.45), and steatorrhea (OR 0.43). Male sex, the only identified predictor for moderate-to-severe complications, was a protective factor (OR 0.19). For the second P-ESWL procedure, complications occurred in 22/409 patients (5.4 %). Complication and asymptomatic hyperamylasemia after the first ESWL session were significantly associated with higher risk for complications after the second ESWL session (P < 0.05).

Conclusions: Patient-related factors were important in determining a high risk of P-ESWL complications when no procedure-related factors were identified. Patients suffering from complications after the first ESWL session were also likely to experience complications in subsequent P-ESWL sessions.

Full Text

References

References
1 Kozarek RA, Ball TJ, Patterson DJ. Endoscopic approach to pancreatic duct calculi and obstructive pancreatitis. Am J Gastroenterol 1992; 87: 600-603
2 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
3 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
4 Hu LH, Liao Z, Li ZS. Spontaneous clearance of pancreatic stones. Clin Gastroenterol Hepatol 2013; 11: e9-e10
5 Sauerbruch T, Holl J, Sackmann M et al. Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study. Gut 1992; 33: 969-972
6 Ong WC, Tandan M, Reddy V et al. Multiple main pancreatic duct stones in tropical pancreatitis: safe clearance with extracorporeal shockwave lithotripsy. J Gastroenterol Hepatol 2006; 21: 1514-1518
7 Tandan M, Reddy DN, Santosh D et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi – a large single center experience. Indian J Gastroenterol 2010; 29: 143-148
8 Hu LH, Liao Z, Li ZS. Rolling in the deep: a quaint sphere rolling in the deep pancreatic duct. Gastroenterology 2013; 145: e7-e8
9 Guda NM, Partington S, Freeman ML. Extracorporeal shock wave lithotripsy in the management of chronic calcific pancreatitis: a meta-analysis. JOP 2005; 6: 6-12
10 Bhasin DK, Rana SS. Extracorporeal shock wave lithotripsy (ESWL) for large pancreatic stones: are these shocks worthwhile?. Indian J Gastroenterol 2010; 29: 133-136
11 Kozarek RA, Brandabur JJ, Ball TJ et al. Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2002; 56: 496-500
12 Inui K, Tazuma S, Yamaguchi T et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy – results of a multicenter survey. Pancreas 2005; 30: 26-30
13 Plaisier PW, den HoedPT. Splenic abscess after lithotripsy of pancreatic duct stones. Dig Surg 2001; 18: 231-232
14 Leifsson BG, Borgstrom A, Ahlgren G. Splenic rupture following ESWL for a pancreatic duct calculus. Dig Surg 2001; 18: 229-230
15 Hirata N, Kushida Y, Ohguri T et al. Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones. J Gastroenterol 1999; 34: 713-716
16 Nakagawa Y, Abe T, Uchida M et al. Hemorrhagic pseudoaneurysm in a pancreatic pseudocyst after extracorporeal shock wave lithotripsy for pancreatolithiasis. Endoscopy 2011; 43: E310-311
17 Tandon RK, Sato N, Garg PK. Chronic pancreatitis: Asia-Pacific consensus report. J Gastroenterol Hepatol 2002; 17: 508-518
18 Hu LH, Liu MH, Liao Z et al. Steinstrasse formation after extracorporeal shock wave lithotripsy for pancreatic stones. Am J Gastroenterol 2012; 107: 1762-1764
19 Cotton PB, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
20 Dumonceau JM, Delhaye M, Tringali A et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012; 44: 784-800
21 Smith LH, Drach G, Hall P et al. National High Blood Pressure Education Program (NHBPEP) review paper on complications of shock wave lithotripsy for urinary calculi. Am J Med 1991; 91: 635-641
22 Lee HY, Yang YH, Shen JT et al. Risk factors survey for extracorporeal shockwave lithotripsy-induced renal hematoma. J Endourol 2013; 27: 763-767
23 Madbouly K, Sheir KZ, Elsobky E et al. Risk factors for the formation of a Steinstrasse after extracorporeal shock wave lithotripsy: a statistical model. J Urol 2002; 167: 1239-1242
24 Cotton PB, Garrow DA, Gallagher J et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88
25 Freeman ML, DiSario JA, Nelson DB et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001; 54: 425-434
26 Wang P, Li ZS, Liu F et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 2009; 104: 31-40
27 Li K, Lin T, Zhang C et al. Optimal frequency of shock wave lithotripsy in urolithiasis treatment: a systematic review and meta-analysis of randomized controlled trials. J Urol 2013; 190: 1260-1267
28 Ohara H, Hoshino M, Hayakawa T et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterol 1996; 91: 1388-1394
29 Al KarawiMA, Mohamed AR, el-Etaibi KE et al. Extracorporeal shock-wave lithotripsy (ESWL)-induced erosions in upper gastrointestinal tract. Prospective study in 40 patients. Urology 1987; 30: 224-227