Management for pancreatolithiasis: a nationwide survey in Japan

Abstract

We performed a nationwide survey of prevailing practices in management of pancreatolithiasis. We collected clinical data from 1834 patients treated for pancreatolithiasis at 125 hospitals. Patients included 1479 men and 355 women. ESWL alone was performed in 103 patients (5.6%); ESWL plus an adjunctive endoscopic procedure in 446 (24.3%); endoscopic treatment alone in 261 (14.2%); and surgery in 167 (9.1%). Other therapies were given to 358 (19.5%) patients. No treatment was considered in 499 (27.2%). Symptom relief rate was 85.7% after ESWL including adjunctive endoscopic treatment, 80.8% after endoscopic treatment alone, and 92.8% after surgery. Early complication rates within 3 months after ESWL including adjunctive endoscopic treatment, endoscopic treatment alone, and surgery were 8%, 4.5%, and 27.1%, respectively. Rates of late complications after ESWL including adjunctive endoscopic treatment, endoscopic procedures alone and surgery were 1.7%, 2.5%, and 8.2%, respectively. Symptom relief rates, but also early and late complication rates, for surgery were significantly higher than for ESWL and endoscopic treatment. Among 417 patients treated with ESWL, 61 (14.6%) required surgery, as did 32 (16.0%) of 200 patients treated endoscopically. Re-operation was required in 11 (6.7%) of 164 patients who were treated with surgery. The need for operation was significantly less frequent after surgery than that for surgery after the other treatments. In Japan, non-surgical treatments were chosen more frequently than surgical treatment for patients with pancreatolithiasis. The first-line treatment of pancreatolithiasis might be ESWL alone or with endoscopy because of minimal invasiveness and low incidence of early complications. Appropriate guidelines for clinical management of pancreatolithiasis should improve efficacy and safety.