Application of ERCP and extracorpareal shock wave lithotripsy in the treatment of chronic pancreatitis with pancreatic duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Rui , WANG Yongjun , JI Ming , LI Peng ,  ZHANG Shutian

Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases; Faculty of Gastroenterology of Capital Medical University; Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, P. R. China;

Corresponding?author：

ZHANG Shutian, Email: zhangst@ccmu.edu.cn

Keywords：

pancreatic duct stone; chronic pancreatitis; endoscopic retrograde cholangiopancreatography; extracorporeal shock wave lithotripsy

DOI：

10.7507/1007-9424.202201010

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Objective To explore the value of endoscopic retrograde cholangiopancreatograph (ERCP) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of pancreatic duct stones. Methods A retrospective collection of 28 patients with chronic pancreatitis and pancreatic duct stones admitted to the Department of Gastroenterology from January 2010 to August 2021 was performed. According to the treatment of patients, they were divided into ERCP direct stone extraction group and ESWL combined ERCP stone extraction group. We compared the treatment effects of the two groups of patients, including the success rate of stone extraction, postoperative complications of ERCP, postoperative symptom improvement, and so on. Results Among the 28 patients, 19 cases underwent ERCP direct stone extraction, and 9 cases underwent ESWL combined with ERCP stone extraction. In the ERCP direct stone extraction group, 7 cases (36.84%) were completely extracted, 1 case was partially extracted (5.26%), and 11 cases (57.89%) failed to extract and only placed stents and drained; 5 cases (26.32%) had elevated white blood cells at 6 hours postoperatively, C-reactive protein increased in 4 cases (21.05%), 3 cases (15.79%) were diagnosed as ERCP-related pancreatitis, and 2 cases (10.53%) were diagnosed as hyperamylaseemia. The abdominal pain symptoms were completely relieved in 14 cases (73.68%) during a follow-up period of 3 to 6 months. The body mass of 17 cases (89.47%) increased in the 6 months after stone extraction. ESWL combined with ERCP had complete stone extraction in 5 cases (55.56%), partial stone extraction in 3 cases (33.33%), and failure in stone extraction and only stent drainage in 1 case (11.11%). One case (11.11%) had elevated white blood cells at 6 hours postoperatively, and 1 case (11.11%) had elevated C-reactive protein . One case (11.11%) was diagnosed with ERCP-related pancreatitis. One case (11.11%) got abdominal pain and transient hematuria during ESWL, which resolved spontaneously 3 days later. After 3 to 6 months of follow-up, 9 patients (100%) had complete relief of abdominal pain symptoms, and the body mass of 9 patients (100%) increased in the 6 months after stone extraction. The stone clearance rate of the ESWL combined with ERCP stone extraction group was higher than that of the ERCP direct stone extraction group (P=0.033), but there was no statistically significant difference between the two groups in terms of ERCP-related complications, relief of abdominal pain, and weight gain (P>0.05). Conclusion ESWL combined with ERCP in the treatment of chronic pancreatitis complicated with pancreatic duct stone extraction is more effective than ERCP direct stone extraction.

Citation： CHENG Rui, WANG Yongjun, JI Ming, LI Peng, ZHANG Shutian. Application of ERCP and extracorpareal shock wave lithotripsy in the treatment of chronic pancreatitis with pancreatic duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(2): 151-156. doi: 10.7507/1007-9424.202201010 Copy

1.	Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med, 1995, 332(22): 1482-1490.
2.	Hu LH, Ye B, Yang YG, et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones: a prospective study of 214 cases. Pancreas, 2016, 45(2): 298-305.
3.	Majumder S, Chari ST. Chronic pancreatitis. Lancet, 2016, 387(10031): 1957-1966.
4.	Sauerbruch T, Holl J, Sackmann M, et al. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis. Endoscopy, 1987, 19(5): 207-208.
5.	劉雨, 胡良皞. 慢性胰腺炎的內鏡治療. 臨床肝膽病雜志, 2020, 36(8): 1691-1697.
6.	莊巖, 田孝東, 高紅橋, 等. 慢性胰腺炎胰腺結石病處理方式選擇. 中華肝臟外科手術學電子雜志, 2019, 8(3): 188-191.
7.	Beyna T, Neuhaus H, Gerges C. Endoscopic treatment of pancreatic duct stones under direct vision: revolution or resignation? Systematic review. Dig Endosc, 2018, 30(1): 29-37.
8.	中國醫師協會胰腺病專業委員會慢性胰腺炎專委會. 慢性胰腺炎診治指南 (2018, 廣州). 臨床肝膽病雜志, 2019, 35(1): 45-51.
9.	Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated August 2018. Endoscopy, 2019, 51(2): 179-193.
10.	Ong WC, Tandan M, Reddy V, et al. Multiple main pancreatic duct stones in tropical pancreatitis: safe clearance with extracorporeal shockwave lithotripsy. J Gastroenterol Hepatol, 2006, 21(10): 1514-1518.
11.	Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
12.	Bai Y, Yu SA, Wang LY, et al. Laparoscopic pancreatic duct incision and stone removal and T-type tube drainage for pancreatic duct stone: a case report and review of literature. World J Clin Cases, 2018, 6(13): 679-682.
13.	焦月, 冀明, 李巍, 等. 兒童慢性胰腺炎多次行ERCP治療18例臨床病例分析. 臨床和實驗醫學雜志, 2018, 17(16): 1787-1790.
14.	李文燕, 冀明, 張澍田. 兒童慢性胰腺炎的病因及內鏡在治療中的價值. 中國微創外科雜志, 2012, 12(7): 615-617.
15.	姜維, 高竹清, 崔淼, 等. 漸進改變支架數量治療兒童及青少年慢性胰腺炎臨床療效分析. 中華消化內鏡志, 2019, 36(3): 185-187.
16.	尹振宇, 劉乾, 李曉梅, 等. ERCP治療胰管結石. 中華肝臟外科手術學電子雜志, 2020, 9(5): 466-470.
17.	王丹, 胡良皞. 體外震波碎石聯合內鏡治療胰管結石. 肝膽外科雜志, 2019, 27(2): 150-152.
18.	趙淑磊, 李鵬, 于中麟, 等. 內鏡聯合體外沖擊波碎石術治療胰管多發結石一例. 中華消化內鏡雜志, 2011, 28(6): 349-350.
19.	Andersson R, L?hr JM; Working Group for Chronic Pancreatitis Guidelines (Sweden). Swedish national guidelines for chronic pancreatitis. Scand J Gastroenterol, 2021, 56(4): 469-483.
20.	Kitano M, Gress TM, Garg PK, et al. International consensus guidelines on interventional endoscopy in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology, 2020, 20(6): 1045-1055.
21.	陳勇軍, 丁志強, 俞亞紅, 等. 胰管結石的分型和外科治療方式的選擇. 中華肝膽外科雜志, 2008, 14(11): 757-758.
22.	吳非, 祁春春, 姜書山, 等. ERCP聯合體外震波碎石治療胰管結石五例. 中華肝膽外科雜志, 2018, 24(8): 560-561.
23.	Heyries L, Sahel J. Endoscopic treatment of chronic pancreatitis. World J Gastroenterol, 2007, 13(46): 6127-6133.
24.	Korpela T, Udd M, Tenca A, et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol, 2016, 51(7): 866-871.
25.	薛鴻鵬, 祝喜萍, 李強. 慢性胰腺炎合并胰管結石的內鏡治療. 中國醫師進修雜志, 2011, 34(28): 67-68.

1. Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med, 1995, 332(22): 1482-1490.
2. Hu LH, Ye B, Yang YG, et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones: a prospective study of 214 cases. Pancreas, 2016, 45(2): 298-305.
3. Majumder S, Chari ST. Chronic pancreatitis. Lancet, 2016, 387(10031): 1957-1966.
4. Sauerbruch T, Holl J, Sackmann M, et al. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis. Endoscopy, 1987, 19(5): 207-208.
5. 劉雨, 胡良皞. 慢性胰腺炎的內鏡治療. 臨床肝膽病雜志, 2020, 36(8): 1691-1697.
6. 莊巖, 田孝東, 高紅橋, 等. 慢性胰腺炎胰腺結石病處理方式選擇. 中華肝臟外科手術學電子雜志, 2019, 8(3): 188-191.
7. Beyna T, Neuhaus H, Gerges C. Endoscopic treatment of pancreatic duct stones under direct vision: revolution or resignation? Systematic review. Dig Endosc, 2018, 30(1): 29-37.
8. 中國醫師協會胰腺病專業委員會慢性胰腺炎專委會. 慢性胰腺炎診治指南 (2018, 廣州). 臨床肝膽病雜志, 2019, 35(1): 45-51.
9. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated August 2018. Endoscopy, 2019, 51(2): 179-193.
10. Ong WC, Tandan M, Reddy V, et al. Multiple main pancreatic duct stones in tropical pancreatitis: safe clearance with extracorporeal shockwave lithotripsy. J Gastroenterol Hepatol, 2006, 21(10): 1514-1518.
11. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
12. Bai Y, Yu SA, Wang LY, et al. Laparoscopic pancreatic duct incision and stone removal and T-type tube drainage for pancreatic duct stone: a case report and review of literature. World J Clin Cases, 2018, 6(13): 679-682.
13. 焦月, 冀明, 李巍, 等. 兒童慢性胰腺炎多次行ERCP治療18例臨床病例分析. 臨床和實驗醫學雜志, 2018, 17(16): 1787-1790.
14. 李文燕, 冀明, 張澍田. 兒童慢性胰腺炎的病因及內鏡在治療中的價值. 中國微創外科雜志, 2012, 12(7): 615-617.
15. 姜維, 高竹清, 崔淼, 等. 漸進改變支架數量治療兒童及青少年慢性胰腺炎臨床療效分析. 中華消化內鏡志, 2019, 36(3): 185-187.
16. 尹振宇, 劉乾, 李曉梅, 等. ERCP治療胰管結石. 中華肝臟外科手術學電子雜志, 2020, 9(5): 466-470.
17. 王丹, 胡良皞. 體外震波碎石聯合內鏡治療胰管結石. 肝膽外科雜志, 2019, 27(2): 150-152.
18. 趙淑磊, 李鵬, 于中麟, 等. 內鏡聯合體外沖擊波碎石術治療胰管多發結石一例. 中華消化內鏡雜志, 2011, 28(6): 349-350.
19. Andersson R, L?hr JM; Working Group for Chronic Pancreatitis Guidelines (Sweden). Swedish national guidelines for chronic pancreatitis. Scand J Gastroenterol, 2021, 56(4): 469-483.
20. Kitano M, Gress TM, Garg PK, et al. International consensus guidelines on interventional endoscopy in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology, 2020, 20(6): 1045-1055.
21. 陳勇軍, 丁志強, 俞亞紅, 等. 胰管結石的分型和外科治療方式的選擇. 中華肝膽外科雜志, 2008, 14(11): 757-758.
22. 吳非, 祁春春, 姜書山, 等. ERCP聯合體外震波碎石治療胰管結石五例. 中華肝膽外科雜志, 2018, 24(8): 560-561.
23. Heyries L, Sahel J. Endoscopic treatment of chronic pancreatitis. World J Gastroenterol, 2007, 13(46): 6127-6133.
24. Korpela T, Udd M, Tenca A, et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol, 2016, 51(7): 866-871.
25. 薛鴻鵬, 祝喜萍, 李強. 慢性胰腺炎合并胰管結石的內鏡治療. 中國醫師進修雜志, 2011, 34(28): 67-68.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of ERCP and extracorpareal shock wave lithotripsy in the treatment of chronic pancreatitis with pancreatic duct stones

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