Pancreatic Extracorporeal Shock Wave Lithotripsy: Efficient and Effective in Gastroenterologists’ Hands

Pancreatic Extracorporeal Shock Wave Lithotripsy: Efficient and Effective in Gastroenterologists’ Hands

Bret T. Petersen, MD, MASGE, reviewing Jaben IL, et al. Clin Gastroenterol Hepatol 2020 Jul 23.

Extracorporeal shock wave lithotripsy (ESWL) has become the dominant therapy for the treatment of symptomatic pancreatic duct stone obstruction in chronic calcific pancreatitis. In the United States, this therapy has been delivered primarily by consulting urologists on the basis of their familiarity with and control of ESWL resources. Recent evolution in both gastroenterology and urology practices is prompting the migration of this modality into GI suites. 

In this study, the authors compared case complexity, treatment parameters, and outcomes during sequential intervals of ESWL therapy directed by urologists (January 2014-February 2017; 18 patients) and gastroenterologists (March 2017-December 2019; 61 patients). Patient demographics and stone morphologies were equivalent between the periods, but when ESWL was delivered by gastroenterologists, the treatment intensity was higher (4341 vs 3117 shocks per session; P<.001), and higher proportions of patients underwent same-day ERCP (66% vs 6%; P<.001) and reached complete or partial duct clearance (71% vs 44%; P=.04). There were no differences in identified adverse events, but posttreatment hospitalization was utilized more commonly during the interval of therapy delivered by urologists.

Bret T. Petersen, MD, FASGE

COMMENT

As integrated lines of disease management mature, varied treatment modalities may coalesce into teams of providers from single or affiliated specialties. In this case, ESWL for symptomatic pancreatic duct stones was delivered by gastroenterologists with enhanced efficiency and outcomes.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Jaben IL, Cote GA, Forster E, et al. Comparison of urologist- vs gastroenterologist-directed extracorporeal shock wave lithotripsy for pancreaticolithiasis. Clin Gastroenterol Hepatol 2020 Jul 23. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.07.042)

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