Management for Pancreatolithiasis - A Japanese Multicenter Study

Abstract

A Japanese multicenter study of pancreatolithiasis was performed to investigate the clinicopathological features and to determine treatment strategies for pancreatic stones. A retrospective study was performed on 899 patients (752 men and 122 women). The etiology was alcoholic in 666 cases and idiopathic in 114 cases. The treatment method was extracorporeal shock wave lithotripsy (ESWL) in 452 cases, surgery in 133 cases and endoscopy alone in 68 cases. Fragmentation of stones after ESWL was achieved in 92.4% cases. However, stones were cleared completely in 49.4% cases after ESWL alone. The complete stone clearance rate was lower after ESWL than after endoscopy. However, the symptom relief rate after each treatment was over 90%. The incidence of early complications after surgery was significantly higher than after ESWL. On the other hand, the incidence of late complications was higher after ESWL than after endoscopy or surgery, although not significantly. Stone recurrence after ESWL and endoscopy was significantly more frequently than after surgery. After ESWL, abdominal pain recurred significantly more frequently than after surgery. Most recurrences of stones and abdominal pain after ESWL and endoscopy happened within three years. In conclusion, the first-line treatment for pancreatic stones should be ESWL alone or with endoscopy because of its minimal invasiveness and low incidence of early complications. Surgical treatment should be performed for cases in which ESWL and endoscopy failed.