Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study

Stefan Haraldsson; Stine Roug; Camilla Nøjgaard; Srdan Novovic; Lise Lotte Gluud; Erik Feldager; Palle Nordblad Schmidt

doi:10.1080/00365521.2018.1508611

Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study

Stefan Haraldsson, Stine Roug, Camilla Nøjgaard, Srdan Novovic, Lise Lotte Gluud, Erik Feldager, Palle Nordblad Schmidt

Department of Clinical Medicine

2 Citations (Scopus)

Abstract

INTRODUCTION: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups.

AIM: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS.

METHODS: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as 'pain-free without analgesics or with use of weak analgesics as needed'. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048).

RESULTS: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03-1.16; p = .002) as did location of the stone in the head or neck (OR 2.59;1.04-6.45; p = .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p = .002) and the location of the stones (p = .039).

CONCLUSION: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.

Original language	English
Journal	Scandinavian Journal of Gastroenterology
Volume	53
Issue number	10-11
Pages (from-to)	1399-1403
ISSN	0036-5521
DOIs	https://doi.org/10.1080/00365521.2018.1508611
Publication status	Published - 2 Nov 2018

Keywords

Adult
Aged
Analgesics, Opioid/therapeutic use
Denmark
Extracorporeal Shockwave Therapy
Female
Gallstones/therapy
Humans
Lithotripsy/instrumentation
Logistic Models
Male
Middle Aged
Multivariate Analysis
Pain/drug therapy
Pancreatic Diseases/therapy
Pancreatic Ducts/pathology
Retrospective Studies
Treatment Outcome

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10.1080/00365521.2018.1508611

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@article{e00df9a8c803477a8505196ba7c79c75,

title = "Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study",

abstract = "INTRODUCTION: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups.AIM: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS.METHODS: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as 'pain-free without analgesics or with use of weak analgesics as needed'. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048).RESULTS: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03-1.16; p = .002) as did location of the stone in the head or neck (OR 2.59;1.04-6.45; p = .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p = .002) and the location of the stones (p = .039).CONCLUSION: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.",

keywords = "Adult, Aged, Analgesics, Opioid/therapeutic use, Denmark, Extracorporeal Shockwave Therapy, Female, Gallstones/therapy, Humans, Lithotripsy/instrumentation, Logistic Models, Male, Middle Aged, Multivariate Analysis, Pain/drug therapy, Pancreatic Diseases/therapy, Pancreatic Ducts/pathology, Retrospective Studies, Treatment Outcome",

author = "Stefan Haraldsson and Stine Roug and Camilla N{\o}jgaard and Srdan Novovic and Gluud, {Lise Lotte} and Erik Feldager and Schmidt, {Palle Nordblad}",

year = "2018",

month = nov,

day = "2",

doi = "10.1080/00365521.2018.1508611",

language = "English",

volume = "53",

pages = "1399--1403",

journal = "Scandinavian Journal of Gastroenterology",

issn = "0036-5521",

publisher = "Taylor & Francis",

number = "10-11",

}

TY - JOUR

T1 - Extracorporeal shock wave lithotripsy for pancreatic duct stones

T2 - an observational study

AU - Haraldsson, Stefan

AU - Roug, Stine

AU - Nøjgaard, Camilla

AU - Novovic, Srdan

AU - Gluud, Lise Lotte

AU - Feldager, Erik

AU - Schmidt, Palle Nordblad

PY - 2018/11/2

Y1 - 2018/11/2

N2 - INTRODUCTION: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups.AIM: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS.METHODS: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as 'pain-free without analgesics or with use of weak analgesics as needed'. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048).RESULTS: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03-1.16; p = .002) as did location of the stone in the head or neck (OR 2.59;1.04-6.45; p = .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p = .002) and the location of the stones (p = .039).CONCLUSION: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.

AB - INTRODUCTION: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups.AIM: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS.METHODS: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as 'pain-free without analgesics or with use of weak analgesics as needed'. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048).RESULTS: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03-1.16; p = .002) as did location of the stone in the head or neck (OR 2.59;1.04-6.45; p = .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p = .002) and the location of the stones (p = .039).CONCLUSION: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.

KW - Adult

KW - Aged

KW - Analgesics, Opioid/therapeutic use

KW - Denmark

KW - Extracorporeal Shockwave Therapy

KW - Female

KW - Gallstones/therapy

KW - Humans

KW - Lithotripsy/instrumentation

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Pain/drug therapy

KW - Pancreatic Diseases/therapy

KW - Pancreatic Ducts/pathology

KW - Retrospective Studies

KW - Treatment Outcome

U2 - 10.1080/00365521.2018.1508611

DO - 10.1080/00365521.2018.1508611

M3 - Journal article

C2 - 30353766

SN - 0036-5521

VL - 53

SP - 1399

EP - 1403

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

IS - 10-11

ER -

Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study

Abstract

Keywords

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