Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis

BackgroundLong-term results of extracorporeal shockwave lithotripsy (ESWL) for large pancreatic duct (PD) stones in patients with idiopathic calcific pancreatitis (CP) are scanty.ObjectiveTo evaluate intermediate and long-term results of ESWL in a large cohort of patients with idiopathic CP.DesignCross-sectional study; retrospective chart review.SettingA high-volume, tertiary-care center for endoscopy and GI diseases.PatientsA total of 636 patients with idiopathic CP who underwent ESWL and ERCP were followed-up. Patients were divided into intermediate (24-60 months) and long-term (>60 months) follow-up groups.InterventionESWL and ERCP.Main Outcome MeasurementsImprovement in pain, analgesic use, hospitalization for pain, recurrence of calculi, need for additional intervention, and quality of life.ResultsA total of 636 of 1006 patients who underwent ESWL between 2004 and 2009 were followed for a maximum of 96 months. There were 364 patients in the intermediate follow-up group and 272 in the long-term follow-up group. After ESWL and ERCP, absence of pain was seen in 250 patients (68.7%), mild-to-moderate pain in 94 patients (25.4%), and severe pain in 20 patients (5.5%) of the intermediate group. In the long-term group, 164 patients (60.3%) had no pain, 97 patients (35.7%) had mild or moderate episodes of pain, whereas 11 patients (4.04%) had episodic severe pain. Recurrence of calculi was seen in 51 patients (14.01%) in the intermediate follow-up group and in 62 patients (22.8%) in the long-term group. Quality of life improved in a significant number of patients in both groups.LimitationsRetrospective study, single center, recall bias, and subjective pain and quality-of-life measurement scale.ConclusionESWL for large PD calculi offers good results in patients of idiopathic CP on intermediate and long-term follow-up.