Comments on “Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis”

We read with great interest the article by Gurav et al. [11] reporting predictors of persistent pain after extracorporeal shockwave lithotripsy (ESWL) for painful chronic calcific pancreatitis. However, we have some questions regarding this study.

First, the authors mentioned in the article that patients were included if they had chronic calcific pancreatitis with intraductal obstructive calculi in the head and/or body of the pancreas, but they did not mention the size of the stones. According to the European Society of Gastrointestinal Endoscopy (ESGE) guideline [22], stones smaller than 5 mm could be directly treated with endoscopic retrograde cholangiopancreatography without the need for ESWL. Therefore, the size of the stones is a very important indicator that needs to be mentioned.

Second, we wondered why all patients received pancreatic duct stents after stone fragments were cleared? According to the ESGE guideline [22], stents could be placed in patients with accompanying pancreatic duct strictures. However, in this study, most patients did not have pancreatic duct strictures, so the purpose of placing stents was unclear.

Third, this study only assessed the presence of main pancreatic duct strictures and did not describe the length, diameter, and severity of the strictures, which are closely related to pain and symptom relief after treatment for chronic pancreatitis [33] [44].

In summary, although this study had some limitations, it still provided important clinical evidence for predicting symptom relief after ESWL in patients with chronic calcific pancreatitis.

Publication History

Article published online:
30 October 2024

• References

• 1 Gurav N, Jagtap N, Koppoju V. et al. Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis. Endoscopy 2024; DOI: 10.1055/a-2252-9920.
• 2 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 DOI: 10.1055/a-0822-0832. (PMID: 30654394)
• 3 Sofi AA, Khan MA, Ahmad S. et al. Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis – a systematic review and meta-analysis. Pancreatology 2021; 21: 854-861 DOI: 10.1016/j.pan.2021.03.017. (PMID: 33941467)
• 4 Strand DS, Law RJ, Yang D. et al. AGA clinical practice update on the endoscopic approach to recurrent acute and chronic pancreatitis: expert review. Gastroenterology 2022; 163: 1107-1114 DOI: 10.1053/j.gastro.2022.07.079. (PMID: 36008176)