Comparison of Urologist- vs Gastroenterologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreaticolithiasis

Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial

BACKGROUNDS/OBJECTIVES

Patients with chronic pancreatitis may develop pancreatic duct stones that can obstruct outflow leading to ductal hypertension and pain. Both endoscopic retrograde pancreatography (ERP) with per-oral pancreatoscopy (POP) and intraductal lithotripsy and extracorporeal shock wave lithotripsy (ESWL) are feasible options to attempt ductal stone clearance. This study aims to compare POP-guided lithotripsy with ESWL in the management of refractory symptomatic main pancreatic duct stones.

METHODS

This is an open-label, multi-center, parallel, randomized clinical trial. Patients with chronic pancreatitis and main pancreatic duct stones ≥5 mm who fail standard ERP methods for stone removal will be eligible for this study. In total, 150 subjects will be randomized 1:1 to either ESWL or POP. A maximum of 4 sessions of either ESWL or POP will be allowed in each arm, with crossover permitted thereafter. The primary outcome is complete stone clearance and secondary outcomes include quality of life, pain scores, number of interventions, and daily opiate requirements.

CONCLUSIONS

This study aims to answer the question of which lithotripsy method is superior in removing refractory pancreatic duct stones while addressing the effects of lithotripsy on quality of life and pain in patients with chronic calcific pancreatitis (ClinicalTrials.gov NCT04115826).

Hepatic Abscess After Pancreatic Extracorporeal Shock Wave Lithotripsy

We report the case of a 61-year-old woman with painful chronic pancreatitis related to proximal pancreatic duct pancreatolithiasis who underwent successful fragmentation with pancreatic extracorporeal shock wave lithotripsy (ESWL). Two weeks later, she developed abdominal pain, nausea, and vomiting and was found to have a new 4.6 × 2.3 cm hepatic abscess. She was treated with antibiotics but did not require additional intervention. Reported etiologies of post-ESWL abdominal pain include local irritation and bruising at the interface and pancreatitis, which has been reported in 4.2% of cases. We suggest that hepatic abscess ought to be considered in the differential diagnosis of post-ESWL abdominal pain.