Extracorporeal shock wave lithotripsy is safe and effective for pediatric patients with chronic pancreatitis

Abstract

Background and aims Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is recommended as the first-line treatment for pancreatic stones. However, how well P-ESWL performs in pediatric patients remains unclear. We aimed to evaluate the safety and efficacy of P-ESWL for pediatric patients with chronic pancreatitis. Methods This prospective observational study was conducted in patients with painful chronic pancreatitis who underwent P-ESWL. Patients aged under 18 years were included in the pediatric group; patients aged over 18 years who underwent P-ESWL in the same period were assigned to the control group. For investigation of long-term follow-up, the pediatric group were matched with patients from the control group in a 1:1 ratio. The primary outcomes were P-ESWL complications and pain relief. The secondary outcomes included: stone clearance, physical and mental health, quality of life score, and growth and developmental state. Results From March 2011 to March 2015, P-ESWL was performed in 1135 patients (72 in the pediatric group, 1063 in the control group). No significant differences were observed in the occurrence of P-ESWL complications between the two groups (11.1 % vs. 12.8 %; P = 0.68). Among the 67 pediatric patients (93.1 %) who underwent follow-up for 3.0 years (range 1.3 - 5.2), complete pain relief was achieved in 52 patients (52 /67; 77.6 %); this value was not significantly different from that of the matched controls (55 /69; 79.7 %; P = 0.94). Conclusions P-ESWL is safe and effective for pediatric patients with chronic pancreatitis. It can promote significant pain relief and stone clearance, and can benefit growth and development.

Conflict of interest statement

Competing interests None

© Georg Thieme Verlag KG Stuttgart · New York.

Figures

Fig. 1

The process of pancreatic stone fragmentation and extraction.aA fluoroscopic image showing multiple stones in the head of pancreas before P-ESWL. The image was taken with the patient in a supine position tilting to right in an angle of 30°.bAs shown in the X-ray. Parts of the stones were fragmented after the first P-ESWL.cAfter the second P-ESWL, the pulverized stones were less dense than they were prior to P-ESWL and spread all along the duct. The patient then received a third P-ESWL followed by ERCP.dDuring ERCP, plenty of white pulverized stones were extracted by extraction basket.eAn endoscopic image showing extracted pulverized calculi.fPancreatic stones identified from the stool of the patient.

Fig. 2

The effect of having chronic pancreatitis and of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) on growth in the pediatric group. All comparisons are made with standard heights for the same ages.aHeights of the children (n = 67) before P-ESWL (P < 0.001) and at the end of follow-up (P = 0.005).bHeights of the boys (n = 38) before P-ESWL (P = 0.009) and at the end of follow-up (P = 0.06).cHeights of the girls (n = 29) before P-ESWL (P < 0.001) and at the end of follow-up (P = 0.02).