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Yi JH, Li ZS, Hu LH. Adverse events of pancreatic extracorporeal shock wave lithotripsy: a literature review. BMC Gastroenterol 2023; 23:360. [PMID: 37853330 PMCID: PMC10585860 DOI: 10.1186/s12876-023-02992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
Pancreatic stones are the result of pathophysiologic changes in chronic pancreatitis with an incidence of more than 90%. At present, pancreatic extracorporeal shock wave lithotripsy (P-ESWL) can be used as the first-line treatment for large or complex stones. Although a large number of studies have proven the safety and effectiveness of P-ESWL, we should also pay attention to postoperative adverse events, mainly due to the scattering of shock waves in the conduction pathway. Adverse events can be classified as either complications or transient adverse events according to the severity. Because the anatomic location of organs along the shock wave conducting pathway differs greatly, adverse events after P-ESWL are varied and difficult to predict. This paper outlines the mechanism, definition, classification, management and risk factors for adverse events related to P-ESWL. It also discusses the technique of P-ESWL, indications and contraindications of P-ESWL, and adverse events in special populations.
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Affiliation(s)
- Jin-Hui Yi
- Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
| | - Liang-Hao Hu
- Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
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Tandan M, Pal P, Reddy DN. Management of Pancreatic Duct Stones: Extracorporeal Approach. Gastrointest Endosc Clin N Am 2023; 33:807-820. [PMID: 37709412 DOI: 10.1016/j.giec.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Stone clearance with extracorporeal shock wave lithotripsy is a safe and effective procedure for large pancreatic calculi not extractable by the standard endoscopic retrograde cholangiopancreatography techniques. In properly selected patients, this minimally invasive approach should be offered as the first line of therapy instead of surgery. Complete stone clearance can be achieved in three-fourths with long-term pain relief in two-thirds of patients. Re-intervention is required in less than half of the patients. Future studies should compare the extracorporeal approach with intraductal lithotripsy using the pancreatoscope.
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Affiliation(s)
- Manu Tandan
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, TG 500082, India.
| | - Partha Pal
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, TG 500082, India
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Tanaka S, Yoshida R, Maruyama M, Ando S, Nakamura M, Nakamura T, Yoshizako T. Massive spontaneous nontraumatic subcapsular hepatic hematoma treated using arterial embolization: A case report and review of the literature. Acta Radiol Open 2023; 12:20584601231176284. [PMID: 37197023 PMCID: PMC10184232 DOI: 10.1177/20584601231176284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
A nontraumatic and idiopathic spontaneous subcapsular hepatic hematoma is a rare but often fatal condition. Herein, we report a case of nontraumatic progressive massive subcapsular hepatic hematoma that straddled both liver lobes and was successfully treated by repeated arterial embolization. Following treatment, the hematoma did not progress.
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Affiliation(s)
- Shota Tanaka
- Department of Radiology, Shimane University, Izumo, Japan
- Department of Radiology, Matsue Seikyo Hospital, Matsue, Japan
| | - Rika Yoshida
- Department of Radiology, Shimane University, Izumo, Japan
| | | | - Shinji Ando
- Department of Radiology, Shimane University, Izumo, Japan
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Tandan M, Nageshwar Reddy D, Talukdar R, Vinod K, Kiran SVVS, Santosh D, Gupta R, Ramchandani M, Lakhtakia S, Rakesh K, Manohar Reddy P, Basha J, Nabi Z, Jagtap N, Rao GV. ESWL for large pancreatic calculi: Report of over 5000 patients. Pancreatology 2019; 19:916-921. [PMID: 31447280 DOI: 10.1016/j.pan.2019.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/17/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The primary aim of this study was to evaluate efficacy, safety and short-term pain relief after ESWL for large pancreatic calculi in over 5000 patients at a single center. METHODS This is a retrospective analysis of prospectively collected data. Patients with painful calculi >5 mm, located in the head, neck and body region in the MPD, who were not amenable for extraction by the standard procedure of endoscopic pancreatic sphincterotomy were subjected to ESWL using a third generation dual focus lithotripter. Patients were followed up at 6 months for outcome evaluation. RESULTS A total of 5124 patients (66% males) were subjected to ESWL. Majority of stones (79.2%) were radiopaque. Single calculi were seen in 3851 (75.1%).The majority of stones were located in head region of MPD in 2824 (55.1%) patients. 4386 (85.5%) patients required 3 or less sessions for fragmentation and complete stone clearance was achieved in 3722 (72.6%). EPS was performed in 5022 (98%) while PD stenting was required in 3536 (69%) patients. Of the 4280 patients followed up for 6 months, 3529 (82.6%) patients were pain free. Another 512 (11.9%) patients had significant reduction in VAS score. In 229 (5.3%) there was no decrease in pain intensity. Minor and self-limiting complications were reported in 1153 (22.5%). DISCUSSION Our study confirms the safety and efficacy and short-term pain relief of ESWL for large calculi in the MPD. In properly selected patients, this should be offered as the first line of therapy for all large MPD calculi not amenable to the standard techniques of stone extraction.
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Affiliation(s)
- Manu Tandan
- Asian Institute of Gastroenterology, Hyderabad, India.
| | | | | | - K Vinod
- Asian Institute of Gastroenterology, Hyderabad, India
| | - S V V S Kiran
- Asian Institute of Gastroenterology, Hyderabad, India
| | - D Santosh
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - K Rakesh
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Asian Institute of Gastroenterology, Hyderabad, India
| | - G V Rao
- Asian Institute of Gastroenterology, Hyderabad, India
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Bi YW, Wang D, Du TT, Liao Z, Li ZS, Hu LH. Hepatic subcapsular hematoma breaking into the abdominal cavity after extracorporeal shock wave lithotripsy for pancreatic stones. J Dig Dis 2018; 19:314-317. [PMID: 28749071 DOI: 10.1111/1751-2980.12510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Ya Wei Bi
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ting Ting Du
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liang Hao Hu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
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Tandan M, Talukdar R, Reddy DN. Management of Pancreatic Calculi: An Update. Gut Liver 2017; 10:873-880. [PMID: 27784844 PMCID: PMC5087925 DOI: 10.5009/gnl15555] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022] Open
Abstract
Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.
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Affiliation(s)
- Manu Tandan
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupjyoti Talukdar
- Asian Institute of Gastroenterology, Hyderabad, India.,Asian Healthcare Foundation, Hyderabad, India
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Tao T, Zhang M, Zhang QJ, Li L, Li T, Zhu X, Li MD, Li GH, Sun SX. Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones. World J Gastroenterol 2017; 23:4950-4957. [PMID: 28785149 PMCID: PMC5526765 DOI: 10.3748/wjg.v23.i27.4950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/03/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) vs ERCP only for problematic and large common bile duct (CBD) stones.
METHODS Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups, an “ESWL + ERCP group” and an “ERCP-only” group. For ESWL + ERCP cases, ESWL was performed prior to ERCP. Clearance of the CBD, complications related to the ESWL/ERCP procedure, frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups.
RESULTS There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session (74.2% vs 71.0%, P = 0.135), but a higher clearance rate within the second treatment session (84.4% vs 51.6%, P = 0.018) and total stone clearance (96.0% vs 86.0%, P = 0.029). Moreover, ESWL prior to ERCP not only reduced ERCP procedure time (43 ± 21 min vs 59 ± 28 min, P = 0.034) and the rate of mechanical lithotripsy use (20% vs 30%, P = 0.025), but also raised the clearance rate of extremely large stones (80.0% vs 40.0%, P = 0.016). Post-ERCP complications were similar for the two groups.
CONCLUSION Based on the higher rate of successful stone removal and minimal complications, ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones.
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Tao T, Zhang QJ, Zhang M, Zhu X, Sun SX, Li YQ. Using cholecystokinin to facilitate endoscopic clearance of large common bile duct stones. World J Gastroenterol 2014; 20:10121-10127. [PMID: 25110439 PMCID: PMC4123341 DOI: 10.3748/wjg.v20.i29.10121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/07/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of cholecystokinin (CCK) during extracorporeal shockwave lithotripsy (ESWL) in the clearance of common bile duct (CBD) stones in endoscopic retrograde cholangiopancreatography (ERCP).
METHODS: Between January 2007 and September 2012, patients with large CBD stones who were treated with ESWL and ERCP were identified retrospectively. Patients were randomized in equal numbers to cholecystokinin (CCK) and no CCK groups. For each CCK case, a dose (3 ng/kg per min for 10 min) of sulfated octapeptide of CCK-8 was administered intravenously near the beginning of ESWL. ERCP was performed 4 h after a session of ESWL. The clearance rate of the CBD was assessed between the two groups.
RESULTS: A total of 148 consecutive cases (CCK group: 74, no CCK group: 74) were tallied. Overall there were 234 ESWLs and 228 ERCPs in the 148 cases. The use of CCK showed a significantly higher rate of successful stone removal in the first ESWL/ERCP procedure (71.6% vs 55.4%, P = 0.035), but resulted in similar outcomes in the second (42.8% vs 39.4%) and third (41.7% vs 40.0%) sessions, as well as total stone clearance (90.5% vs 83.8%). The use of mechanical lithotripsy was reduced in the CCK group (6.8% vs 17.6%, P = 0.023), and extremely large stone (≥ 30 mm) removal was higher in the CCK group (72.7% vs 41.7%, P = 0.038).
CONCLUSION: CCK during ESWL can aid with the clearance of CBD stones in the first ESWL/ERCP session. Mechanical lithotripsy usage was reduced and the extremely large stone (≥ 30 mm) clearance rate can be raised.
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Pei YV. Intrahepatic hematoma requiring hepatic artery embolization: a rare complication of extracorporeal shock wave lithotripsy. Am J Emerg Med 2013; 31:1425.e1-2. [PMID: 23791461 DOI: 10.1016/j.ajem.2013.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 11/24/2022] Open
Abstract
Extracorporeal shock wave lithotripsy is a well-established treatment modality for renal calculi since the 1980s (Urology 1984;23(5):59–66). In general, it is a safe and effective noninvasive therapeutic modality for treatment of urolithiasis. Bleeding complications of this procedure are rare and usually involve the kidneys. In this case report, a 56-year-old woman developed severe abdominal pain with signs of hemorrhagic shock 2 days post–extracorporeal shock wave lithotripsy procedure. Computed tomography of the abdomen and pelvis showed a large intrahepatic hemorrhage that required hepatic artery embolization.
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Affiliation(s)
- Y Veronica Pei
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca St, Suite 6200, Baltimore, MD 21201.
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Tandan M, Reddy DN. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones. World J Gastroenterol 2011; 17:4365-71. [PMID: 22110261 PMCID: PMC3218149 DOI: 10.3748/wjg.v17.i39.4365] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 04/11/2011] [Accepted: 04/18/2011] [Indexed: 02/06/2023] Open
Abstract
Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body are targeted by ESWL, with an aim to fragment them to < 3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangiopancreatography (ERCP). In our experience, complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17% of 1006 patients. Short-term pain relief with reduction in the number of analgesics ingested was seen in 84% of these patients. For large CBD calculi, a nasobiliary tube is placed to help target the calculi, as well as bathe the calculi in saline - a simple maneuver which helps to facilitate fragmentation. The aim is to fragment calculi to < 5 mm size and clear the same during ERCP. Complete clearance of the CBD was achieved in 84.4% of and partial clearance in 12.3% of 283 patients. More than 90% of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being delivered at each session. The use of epidural anesthesia helped in reducing patient movement. This, together with the better focus achieved with newer third-generation lithotripters, prevents collateral tissue damage and minimizes the complications. Complications in our experience with nearly 1300 patients were minimal, and no extension of hospital stay was required. Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly. In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.
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Tandan M, Reddy DN, Santosh D, Vinod K, Ramchandani M, Rajesh G, Rama K, Lakhtakia S, Banerjee R, Pratap N, Venkat Rao G. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience. Indian J Gastroenterol 2010; 29:143-8. [PMID: 20717860 DOI: 10.1007/s12664-010-0035-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 03/23/2010] [Indexed: 02/07/2023]
Abstract
AIM Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP. METHODS Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal. CONCLUSION ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.
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Affiliation(s)
- Manu Tandan
- Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad 500082, India.
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Kim TB, Park HK, Lee KY, Kim KH, Jung H, Yoon SJ. Life-threatening complication after extracorporeal shock wave lithotripsy for a renal stone: a hepatic subcapsular hematoma. Korean J Urol 2010; 51:212-5. [PMID: 20414400 PMCID: PMC2855451 DOI: 10.4111/kju.2010.51.3.212] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/22/2010] [Indexed: 11/18/2022] Open
Abstract
Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of urolithiasis since it was first introduced in 1980. ESWL is a well-established, safe and effective therapeutic alternative to surgical treatment for urolithiasis. Complications of ESWL do occur in a small number of patients, and when they do, they typically involve the kidney. We present a case of a young female patient who developed a huge hepatic subcapsular hematoma accompanied by hypovolemic shock after ESWL for a 9 mm stone in the right kidney. The hematoma measured 13×6 cm. Conservative care with no surgical intervention was chosen because there was no evidence of active bleeding on the computed tomography. After conservative therapy, the hematoma was gradually absorbed and the patient was discharged.
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Affiliation(s)
- Tae-Beom Kim
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
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Beatrice J, Strebel RT, Pfammatter T, Röhweder JH, Sulser T. Life-threatening complication after right renal extracorporeal shock wave lithotripsy: large hepatic haematoma requiring embolisation of the right hepatic artery: Part 2. Eur Urol 2007; 52:1252-3. [PMID: 17933027 DOI: 10.1016/j.eururo.2007.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Josef Beatrice
- Department of Urology, University Hospital Zurich, Switzerland.
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Bogdanovic J, Djozic J. Re: Josef Beatrice, raeto T. Strebel, Thomas Pfammatter, Jaime H. Röhweder and Tullio Sulser. Life-threatening complication after right renal extracorporeal shock wave lithotripsy: large hepatic haematoma requiring embolisation of the right hepatic artery. Eur Urol 2007;52:909-11. Eur Urol 2007; 52:1799-800. [PMID: 17693014 DOI: 10.1016/j.eururo.2007.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Accepted: 07/27/2007] [Indexed: 11/23/2022]
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Ong WC, Tandan M, Reddy V, Rao GV, Reddy N. Multiple main pancreatic duct stones in tropical pancreatitis: safe clearance with extracorporeal shockwave lithotripsy. J Gastroenterol Hepatol 2006; 21:1514-8. [PMID: 16928210 DOI: 10.1111/j.1440-1746.2006.04224.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Extracorporeal shockwave lithotripsy (ESWL) has an established role in the management of pancreatic ductal stones. Its efficacy in management of multiple stones in tropical pancreatitis is unknown. The aim of this study was to prospectively evaluate: (i) the efficacy of main pancreatic duct stone clearance; and (ii) associated complications with ESWL therapy in tropical pancreatitis. METHODS Consecutively recruited patients with tropical pancreatitis underwent fragmentation of main pancreatic duct stones using ESWL. Endoscopic retrograde cholangiopancreatography (ERCP) using standard techniques was performed to manage residual stones. Complete, partial and unsatisfactory clearance was defined as >90%, 50-90% and <50% of stone clearance, respectively. Clinical and technical data were collected on a pre-formatted data sheet. Statistical analysis was performed on an intention-to-treat basis. RESULTS A total of 250 patients (mean+/-SD age 35.2+/-11.9 years; 66% men), 86.8% with multiple radio-opaque stones, underwent ESWL between February 2004 and May 2005. Of the 250 patients, 149 (59.6%) achieved complete clearance and 59 (23.6%) achieved partial clearance of pancreatic calculi. Main pancreatic ductal decompression was achieved in 70.0% (175/250) of patients. Complications occurred in 5.6% (14/250) during ESWL and in 1.2% (3/250) during ERCP. A mean of 1.3 sessions, with mean+/-SD 5.5+/-0.7 intensity setting, 85.8+/-13.5 pulses per minute and 3862+/-1426 shocks per session were required. CONCLUSION Clearance of multiple main pancreatic duct stones in patients with tropical pancreatitis is safely performed via ESWL followed by ERCP ductal drainage.
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Vimalraj V, Surendran R, Sekar KS, Rajendran N. Massive hemoptysis in a patient with chronic pancreatitis. J Thorac Cardiovasc Surg 2005; 130:910-1. [PMID: 16153960 DOI: 10.1016/j.jtcvs.2005.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 03/28/2005] [Indexed: 11/19/2022]
Affiliation(s)
- V Vimalraj
- Department of Surgical Gastroenterology, Government Stanley Medical College and Hospital, Chennai, India.
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