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Open Access 01-12-2015 | Research article

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

Authors: Masahiro Maruyama, Takayuki Watanabe, Keita Kanai, Takaya Oguchi, Jumpei Asano, Tetsuya Ito, Takashi Muraki, Hideaki Hamano, Norikazu Arakura, Takeshi Uehara, Shigeyuki Kawa

Published in: BMC Gastroenterology | Issue 1/2015

Abstract

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.

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Title: Extracorporeal shock wave lithotripsy treatment of pancreatic stones complicated with advanced stage autoimmune pancreatitis
Authors: Masahiro Maruyama
Takayuki Watanabe
Keita Kanai
Takaya Oguchi
Jumpei Asano
Tetsuya Ito
Takashi Muraki
Hideaki Hamano
Norikazu Arakura
Takeshi Uehara
Shigeyuki Kawa
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Gastroenterology / Issue 1/2015
Electronic ISSN: 1471-230X
DOI: https://doi.org/10.1186/s12876-015-0255-9

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

Abstract

Background

Methods

Results

Conclusions

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