Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
Abstract
Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
참고문헌 (27)
- Inui K, "Japanese clinical guidelines for endoscopic treatment of pancreatolithiasis", Pancreas, 44, pp.1053~1064 (2015)
- Tandan M, "Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis", Gastrointest Endosc, 78, pp.726~733 (2013)
- Inui K, "Management of pancreatolithiasis : a nationwide survey in Japan", Pancreas, 47, pp.708~714 (2018)
- Dumonceau JM, "Endoscopic treatment of chronic pancreatitis : European Society of Gastrointestinal Endoscopy(ESGE)Guideline-updated August 2018", Endoscopy, 51, pp.179~193 (2019)
- Gupta NP, "Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi", BJU Int, 95, pp.1285~1288 (2005)
- Ohyama H, "Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones", Pancreas, 44, pp.422~428 (2015)
- Li BR, "Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy", Endoscopy, 46, pp.1092~1100 (2014)
- Merrill JT, "Timing of endoscopy after extracorporeal shock wave lithotripsy for chronic pancreatitis", Pancreas, 40, pp.1087~1090 (2011)
- Jain A, "Effect of air bubbles in the coupling medium on efficacy of extracorporeal shock wave lithotripsy", Eur Urol, 51, pp.1680~1687 (2007)
- Costamagna G, "Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis : immediate and medium-term results", Gastrointest Endosc, 46, pp.231~236 (1997)
- Hao L, "Extracorporeal shock wave lithotripsy is safe and effective for geriatric patients with chronic pancreatitis", J Gastroenterol Hepatol, 34, pp.466~473 (2019)
- Hu LH, "Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones : a prospective study of 214 cases", Pancreas, 45, pp.298~305 (2016)
- Brand B, "Prospective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis", Am J Gastroenterol, 95, pp.3428~3438 (2000)
- Sherman S, "Pancreatic ductal stones : frequency of successful endoscopic removal and improvement in symptoms", Gastrointest Endosc, 37, pp.511~517 (1991)
- Inui K, "Treatment of pancreatic stones with extracorporeal shock wave lithotripsy : results of a multicenter survey", Pancreas, 30, pp.26~30 (2005)
- Tandan M, "Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience", Indian J Gastroenterol, 29, pp.143~148 (2010)
- Sauerbruch T, "Treatment of biliary stones using extracorporeal shock waves(ESWL)", Hepatogastroenterology, 36, pp.309~312 (1989)
- Delhaye M, "Extracorporeal shock-wave lithotripsy of pancreatic calculi", Gastroenterology, 102, pp.610~620 (1992)
- Kozarek RA, "Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis", Gastrointest Endosc, 56, pp.496~500 (2002)
- Dumonceau JM, "Treatment for painful calcified chronic pancreatitis : extracorporeal shock wave lithotripsy versus endoscopic treatment : a randomised controlled trial", Gut, 56, pp.545~552 (2007)
- Dumonceau JM, "Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones : long-term results", Gastrointest Endosc, 43, pp.547~555 (1996)
- Milovic V, "Extracorporeal shock wave lithotripsy with a transportable mini-lithotripter and subsequent endoscopic treatment improves clinical outcome in obstructive calcific chronic pancreatitis", Gastrointest Endosc, 74, pp.1294~1299 (2011)
- Li BR, "Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts", Gastrointest Endosc, 84, pp.69~78 (2016)
- Wang D, "Extracorporeal shock wave lithotripsy for chronic pancreatitis patients with stones after pancreatic surgery", Pancreas, 47, pp.609~616 (2018)
- Lee C, "Impact of learning curve on efficacy of shock wave lithotripsy", Radiol Technol, 80, pp.20~24 (2008)
- Karakayali F, "Acute necrotizing pancreatitis as a rare complication of extracorporeal shock wave lithotripsy", Int J Urol, 13, pp.613~615 (2006)
- Ru N, "Post-ESWL and post-ERCP pancreatitis in patients with chronic pancreatitis : do they share the same risks?", J Hepatobiliary Pancreat Sci, 28, pp.778~787 (2021)