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.

^* Contributed equally to this study.

• References

• 1 Yadav D, Timmons L, Benson JT. et al. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol 2011; 106: 2192-2199
• 2 Spanier B, Bruno MJ, Dijkgraaf MG. Incidence and mortality of acute and chronic pancreatitis in the Netherlands: a nationwide record-linked cohort study for the years 1995–2005. W J Gastroenterol 2013; 19: 3018-3026
• 3 Hirota M, Shimosegawa T, Masamune A. et al. The sixth nationwide epidemiological survey of chronic pancreatitis in Japan. Pancreatology 2012; 12: 79-84
• 4 Schwarzenberg SJ, Bellin M, Husain SZ. et al. Pediatric chronic pancreatitis is associated with genetic risk factors and substantial disease burden. J Pediatr 2015; 166: 890-896.e891
• 5 Kolodziejczyk E, Wejnarska K, Dadalski M. et al. The nutritional status and factors contributing to malnutrition in children with chronic pancreatitis. Pancreatology 2014; 14: 275-279
• 6 Chowdhury SD, Chacko A, Ramakrishna BS. et al. Clinical profile and outcome of chronic pancreatitis in children. Ind Pediatr 2013; 50: 1016-1019
• 7 Wang W, Liao Z, Li ZS. et al. Chronic pancreatitis in Chinese children: etiology, clinical presentation and imaging diagnosis. J Gastroenterol Hepatol 2009; 24: 1862-1868
• 8 Agarwal J, NageshwarReddy D, Talukdar R. et al. ERCP in the management of pancreatic diseases in children. Gastrointest Endosc 2014; 79: 271-278
• 9 Maydeo A, Soehendra N, Reddy N. et al. Endotherapy for chronic pancreatitis with intracanalar stones. Endoscopy 2007; 39: 653-658
• 10 Majumder S, Chari ST. Chronic pancreatitis. Lancet 2016; 387: 1957-1966
• 11 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012; 44: 784-800
• 12 Hsu RK, Draganov P, Leung JW. et al. Therapeutic ERCP in the management of pancreatitis in children. Gastrointest Endosc 2000; 51: 396-400
• 13 Rollins MD, Meyers RL. Frey procedure for surgical management of chronic pancreatitis in children. J Pediatr Surg 2004; 39: 817-820
• 14 Iqbal CW, Moir CR, Ishitani MB. Management of chronic pancreatitis in the pediatric patient: endoscopic retrograde cholangiopancreatography vs operative therapy. J Pediatr Surg 2009; 44: 139-143 ; discussion 143
• 15 Li ZS, Wang W, Liao Z. et al. A long-term follow-up study on endoscopic management of children and adolescents with chronic pancreatitis. Am J Gastroenterol 2010; 105: 1884-1892
• 16 Tandon RK, Sato N, Garg PK. Chronic pancreatitis: Asia–Pacific consensus report. J Gastroenterol Hepatol 2002; 17: 508-518
• 17 Li BR, Liao Z, Du TT. et al. Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy. Endoscopy 2014; 46: 1092-1100
• 18 Yang YG, Hu LH, Chen H. et al. Target-controlled infusion of remifentanil with or without flurbiprofen axetil in sedation for extracorporeal shock wave lithotripsy of pancreatic stones: a prospective, open-label, randomized controlled trial. BMC Anesthesiol 2015; 15: 161
• 19 Dumonceau JM, Garcia-Fernandez FJ, Verdun FR. et al. Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline. Endoscopy 2012; 44: 408-421
• 20 Bloechle C, Izbicki JR, Knoefel WT. et al. Quality of life in chronic pancreatitis--results after duodenum-preserving resection of the head of the pancreas. Pancreas 1995; 11: 77-85
• 21 Cahen DL, Gouma DJ, Nio Y. et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. NEJM 2007; 356: 676-684
• 22 Seven G, Schreiner MA, Ross AS. et al. Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2012; 75: 997-1004 e1001
• 23 Tandan M, Reddy DN, Santosh D. et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience. Ind J Gastroenterol 2010; 29: 143-148
• 24 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: 298-305
• 25 Li BR, Liao Z, Du TT. et al. Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts. Gastrointest Endosc 2016; 84: 69-78
• 26 Oracz G, Pertkiewicz J, Kierkus J. et al. Efficiency of pancreatic duct stenting therapy in children with chronic pancreatitis. Gastrointest Endosc 2014; 80: 1022-1029
• 27 Inui K, Tazuma S, Yamaguchi T. et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas 2005; 30: 26-30
• 28 Moole H, Jaeger A, Bechtold ML. et al. Success of extracorporeal shock wave lithotripsy in chronic calcific pancreatitis management: a meta-analysis and systematic review. Pancreas 2016; 45: 651-658
• 29 Kumar S, Ooi CY, Werlin S. et al. Risk factors associated with pediatric acute recurrent and chronic pancreatitis: lessons from INSPPIRE. JAMA Pediatr 2016; 170: 562-569
• 30 Longo JA, Netto Junior NR. Extracorporeal shock-wave lithotripsy in children. Urology 1995; 46: 550-552
• 31 Kurien A, Symons S, Manohar T. et al. Extracorporeal shock wave lithotripsy in children: equivalent clearance rates to adults is achieved with fewer and lower energy shock waves. BJU Int 2009; 103: 81-84
• 32 de-Madaria E, Abad-Gonzalez A, Aparicio JR. et al. [Recommendations of the Spanish Pancreatic Club on the diagnosis and treatment of chronic pancreatitis: part 2 (treatment)]. Gastroenterol Hepatol 2013; 36: 422-436
• 33 Toouli J, Biankin AV, Oliver MR. et al. Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations. Med J Aus 2010; 193: 461-467
• 34 Li H, Ji CY, Zong XN. et al. [Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years]. Zhonghua Er Ke Za Zhi 2009; 47: 487-492
• 35 Weber TR, Keller MS. Operative management of chronic pancreatitis in children. Arch Surg 2001; 136: 550-554