Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis : A Sham-Controlled, Randomized Trial.
Ann Intern Med
; 177(6): 749-758, 2024 Jun.
Article
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| MEDLINE
| ID: mdl-38801774
ABSTRACT
BACKGROUND:
No randomized controlled trials have substantiated endoscopic decompression of the pancreatic duct in patients with painful chronic pancreatitis.OBJECTIVE:
To investigate the pain-relieving effect of pancreatic duct decompression in patients with chronic pancreatitis and intraductal stones.DESIGN:
24-week, parallel-group, randomized controlled trial (ClinicalTrials.gov NCT03966781).SETTING:
Asian Institute of Gastroenterology in India from February 2021 to July 2022.PARTICIPANTS:
106 patients with chronic pancreatitis. INTERVENTION Combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) compared with sham procedures. MEASUREMENTS The primary end point was pain relief on a 0- to 10-point visual analog scale (VAS) at 12 weeks. Secondary outcomes were assessed after 12 and 24 weeks and included 30% pain relief, opioid use, pain-free days, questionaries, and complications to interventions.RESULTS:
52 patients in the ESWL/ERP group and 54 in the sham group were included. At 12 weeks, the ESWL/ERP group showed better pain relief compared with the sham group (mean difference in change, -0.7 [95% CI, -1.3 to 0] on the VAS; P = 0.039). The difference between groups was not sustained at the 24-week follow-up, and no differences were seen for 30% pain relief at 12- or 24-week follow-up. The number of pain-free days was increased (median difference, 16.2 days [CI, 3.9 to 28.5 days]), and the number of days using opioids was reduced (median difference, -5.4 days [CI, -9.9 to -0.9 days]) in the ESWL/ERP group compared with the sham group at 12-week follow-up. Safety outcomes were similar between groups.LIMITATION:
Single-center study and limited duration of follow-up.CONCLUSION:
In patients with chronic pancreatitis and intraductal stones, ESWL with ERP provided modest short-term pain relief. PRIMARY FUNDING SOURCE Asian Institute of Gastroenterology and Aalborg University Hospital.
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Conductos Pancreáticos
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Litotricia
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Colangiopancreatografia Retrógrada Endoscópica
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Pancreatitis Crónica
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Intern Med
Año:
2024
Tipo del documento:
Article