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Timing of ERCP after extracorporeal shock wave lithotripsy for large main pancreatic duct stones

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Abstract

Background and aims

Extracorporeal shock wave lithotripsy (ESWL) is performed to fragment large main pancreatic duct (MPD) stones in symptomatic patients. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) is often performed to clear the stone fragments. Edema of surrounding tissue after ESWL theoretically affects the ability to perform ERCP. However, the optimal timing of ERCP after ESWL is not clearly defined. The aim of this study is to determine the efficacy and safety of same-day ERCP after ESWL and to determine if the timing of ERCP after ESWL affects outcomes.

Methods

This is a retrospective study of consecutive patients from January, 2013 to September, 2019 who received ESWL for MPD stones at our center. Included patients received subsequent same-day ERCP under the same general anesthesia session or later session ERCP (1–30 days after ESWL). Demographics, anatomical findings, history, and outcomes were collected. Success was defined as complete or near complete (> 80%) stone fragmentation with clearance.

Results

218 patients were treated with ESWL and subsequent ERCP. 133 (61.0%) received ERCP on the same day immediately after ESWL, while 85 (39.0%) returned for ERCP at a later day (median 3.0 days after ESWL). Baseline characteristics demonstrated patients who received same-day ERCP had a higher rate of pain at baseline (94.7% vs 87.1%, p = 0.045). Main outcomes demonstrated an overall successful MPD stone clearance rate of 90.4%, with similar rates between same-day ERCP and later session ERCP (91.7% vs 88.2%, p = 0.394). Additionally, successful cannulation at ERCP, adverse events, and post-procedure admission rates were similar.

Conclusions

Delaying ERCP to allow peripancreatic tissue recovery after ESWL does not affect outcomes. Same-day ERCP after ESWL is safe and effective.

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Acknowledgements

The authors would like to give special thanks to Seth Hendress, BS, RT (radiology technologist) for his dedication to these patients and to improving the process of ESWL.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 University Blvd, Suite UH1602, Indianapolis, IN, 46202-5250, USA

    Nasir Saleem, Feenalie Patel, James L. Watkins, Lee McHenry, Jeffrey J. Easler, Evan L. Fogel, Mark A. Gromski, Glen A. Lehman, Stuart Sherman & Benjamin L. Bick

  2. Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA

    Yan Tong

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  1. Nasir Saleem
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  2. Feenalie Patel
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  6. Evan L. Fogel
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Contributions

NS, FP, JJE, and SS: conception/design, analysis/interpretation, critical revision, final approval; JLW, LM, ELF, MAG, and GAL: analysis/interpretation, critical revision, final approval; YT: manuscript review and revision; BLB: conception/design, analysis/interpretation, drafting article, critical revision, final approval.

Corresponding author

Correspondence to Nasir Saleem.

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Disclosures

Jeffrey J. Easler reports that he is a consultant for Boston Scientific (Marlborough, MA). Glen A. Lehman reports that he is a consultant for Cook Medical (Bloomington, IN). Stuart Sherman reports that he is a consultant for Cook Medical (Bloomington, IN), Olympus America (Center Valley, PA) and Boston Scientific (Marlborough, MA). Mark A. Gromski is a consultant for Boston Scientific (Marlborough, MA). Nasir Saleem, Feenalie Patel, James L. Watkins, Lee McHenry, Evan L. Fogel, Yan Tong and Benjamin L. Bick have no conflicts of interest or financial ties to disclose.

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Saleem, N., Patel, F., Watkins, J.L. et al. Timing of ERCP after extracorporeal shock wave lithotripsy for large main pancreatic duct stones. Surg Endosc 37, 9098–9104 (2023). https://doi.org/10.1007/s00464-023-10467-2

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