Extracorporeal shock wave lithotripsy treatment of pancreatic stones complicated with advanced stage autoimmune pancreatitis

BMC Gastroenterology

Shigeyuki Kawa³  Takeshi Uehara⁴  Norikazu Arakura²  Hideaki Hamano¹  Takashi Muraki¹  Tetsuya Ito¹  Jumpei Asano¹  Takaya Oguchi¹  Keita Kanai¹  Takayuki Watanabe¹  Masahiro Maruyama¹ 

[1] Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan;Endoscopic Examination Center, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan;Center for Health, Safety, and Environmental Management, Shinshu University, 3-1-1 Asahi, Matsumoto 390-8621, Japan;Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan

关键词: Endoscopic retrograde cholangiopancreatography;    Extracorporeal shock wave lithotripsy;    Pancreatic calculi;    Pancreatic stone;    Chronic pancreatitis;    Autoimmune pancreatitis;   

Others  :  1144755
DOI  :  10.1186/s12876-015-0255-9

 received in 2014-09-16, accepted in 2015-02-20,  发布年份 2015

【 摘 要 】

Background

Although most patients with autoimmune pancreatitis (AIP) respond favorably to prednisolone therapy, some individuals who later suffer from pancreatic calculi may require additional extracorporeal shock wave lithotripsy (ESWL) treatment. This study compares the efficacy of ESWL for calculi in AIP with that in ordinary chronic pancreatitis (CP) and proposes a new treatment approach for pancreatic duct stones occurring in AIP.

Methods

We examined the clinical records of 8 patients with chronic stage AIP and 92 patients with ordinary CP who received ESWL for pancreatic calculi.

Results

The AIP group was significantly older than the CP group (69.0 vs. 56.5 years, P = 0.018). With regard to the indications for ESWL, chronic pain was significantly less frequent in the chronic stage AIP group (0% vs. 45.7%, P = 0.001), whereas preservation of pancreatic function was significantly more frequent (75% vs. 19.6%, P = 0.001). Compared with the CP group, the AIP group tended to exhibit pancreatic duct stenosis proximal to pancreatic calculi and had a lower rate of complete extraction of stones from the main pancreatic duct. Histopathological analysis of a patient with chronic stage AIP revealed widely distributed nodular pancreatitis, which was characteristic of ordinary CP, along with isolated areas of lymphoplasmacytic sclerosing pancreatitis.

Conclusions

Different approaches are needed for the treatment of pancreatic calculi in chronic stage AIP and ordinary CP. Specifically, it appears that intensive ESWL therapy can be avoided or delayed in AIP if the patient displays: (1) advanced age, (2) little or no chronic pain or pancreatitis, and (3) pancreatic duct stenosis proximal to pancreatic stones. In such cases, the benefit of ESWL treatment may be outweighed by the risks involved in this procedure.

【 授权许可】

   
2015 Maruyama et al.; licensee BioMed Central.

【 图 表 】

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