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

BMC Gastroenterology

Research Article

Shigeyuki Kawa¹  Hideaki Hamano²  Keita Kanai²  Masahiro Maruyama²  Takaya Oguchi²  Jumpei Asano²  Tetsuya Ito²  Takashi Muraki²  Takayuki Watanabe²  Takeshi Uehara³  Norikazu Arakura⁴ 

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

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

DOI  :  10.1186/s12876-015-0255-9

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

来源: Springer

【 摘 要 】

BackgroundAlthough 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.MethodsWe examined the clinical records of 8 patients with chronic stage AIP and 92 patients with ordinary CP who received ESWL for pancreatic calculi.ResultsThe 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.ConclusionsDifferent 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】

Unknown   
© Maruyama et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.