Extracorporeal shock-wave lithotripsy, endoscopy beneficial for pancreatitis

For patients with chronic pancreatitis and intraductal stones, combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) provides pain relief at 12 weeks, according to a study published online May 28 in the Annals of Internal Medicine.

Rupjyoti Talukdar, M.D., from the Asian Institute of Gastroenterology in Hyderabad, India, and colleagues examined the pain-relieving effect of pancreatic duct decompression in 106 patients with chronic pancreatitis and intraductal stones. Combined ESWL and ERP were compared to sham procedures (52 and 54 patients, respectively); the primary end point was pain relief at 12 weeks.

The researchers found that the ESWL/ERP group showed better pain relief than the sham group at 12 weeks (mean difference in change, −0.7 on the visual analog scale). At the 24-week follow-up, the difference between the groups was not sustained; no differences were seen between the groups in 30% pain relief at 12- or 24-week follow-up. Compared with the sham group, patients in the ESWL/ERP group experienced an increase in the number of pain-free days (median difference, 16.2 days) and a reduction in the number of days using opioids (median difference, −5.4 days) at 12-week follow-up. The groups had similar safety outcomes.

“Compared with a sham procedure, pancreatic ductal clearance using combined ESWL/ERP provided modest short-term pain relief in patients with chronic pancreatitis and intraductal stones,” the authors write.

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