P1428 - The Predictive Factors of Early Successful Endoscopic Removal in Chronic Pancreatitis with Pancreaticolithiasis Patients After Extracorporeal Shock Wave Lithotripsy in Thailand

Thanawin Saewong, MD¹, Tanawat Pattarapuntakul, MD¹, Nisa Netinatsunton, MD², Thanapon Yaowmaneerat, MD², Kamonwon Cattapan, MD^3
1Songklanagarind Hospital, Prince of Songkla University, Hatyai, Songkhla, Thailand; ²NKC Institute of Gastroenterology and Hepatology Songklanagarind Hospital, Prince of Songkla University, Hatyai, Songkhla, Thailand; ³Prince of Songkla University, Hatyai, Songkhla, Thailand

Introduction: Chronic pancreatitis patients with symptomatic obstructed main pancreatic duct (MPD) are managed by endoscopic therapy and/or extracorporeal shock wave lithotripsy (ESWL). ESWL is recommended in obstructed MPD stones larger than 5 mm located in the head/body of the pancreas. The predictive factors of early complete pancreatic duct stone removal after extracorporeal shock wave lithotripsy are variable. Characteristics of pancreatic duct stones and pre-ESWL endotherapy were assessed to evaluate predictive factors.

Methods: We evaluated 27 consecutive patients with complete pancreatic duct stones removal by ESWL and endoscopic retrograde cholangiopancreatography (ERCP) between July 2012 and July 2022. Patient characteristics, imaging findings, and pre-ESWL endotherapy were evaluated. Patients with early complete stone removal were compared with those with late stone removal. The optimal cut-off value of variables to differentiate early from late complete stone removal was determined by receiver operating characteristic analysis.

Results: Twenty-seven patients had complete stone removal. 16/27 (59.3%) of chronic pancreatitis patients were caused by alcohol. Early endoscopic removal was achieved in 20 patients (74%). Early endoscopic removal was defined by not greater than three attempts of ERCP to clear the MPD stone. When the stone density threshold was set at 1300 Housefield units, early endoscopic removal was achieved in 16 patients (80%) with lower-density stones. Total numbers of ESWL sessions, pre-ESWL endotherapy, and MPD stricture were comparable between the two groups. In multivariate analysis, the maximal size diameter of the stone
less than 10 mm(P = 0.029) and lower-density stone (P = 0.032) was associated with early endoscopic removal.





Table 1. Baseline patient characteristics and intervention (n=27)

Variables	All Cohort (n=27)	Early endoscopic removal ≤3, (n=20)	Late endoscopic removal > 3, (n=7)	p-Value
Age, mean (SD), y	44 (9.6)	44.1 (9.7)	43.9 (9.9)	0.963
Etiology of pancreatitis, n (%)				0.902
Alcohol	16 (59.3)	12 (60)	4 (57.1)
Interventions, n (%)
Pre-ESWL ERCP	15 (55.6%)	10 (50%)	5 (71.4%)	0.408
PD stricture	18 (66.7%)	13 (65%)	5 (71.4%)	1
PD stent	23 (85.2%)	18 (90%)	5 (71.4%)	0.269
Total No. of ESWL, median (IQR)	2 (1,4)	2 (1,2.5)	4 (2.5,5.5)	0.122

Discussion: Pancreatic duct stone size and density of stone on non-contrast computed tomography (NCCT), but not pancreatic duct stricture or pre-ESWL endotherapy can predict the success of endoscopic clearance.



Disclosures:


Thanawin Saewong, MD¹, Tanawat Pattarapuntakul, MD¹, Nisa Netinatsunton, MD², Thanapon Yaowmaneerat, MD², Kamonwon Cattapan, MD³. P1428 - The Predictive Factors of Early Successful Endoscopic Removal in Chronic Pancreatitis with Pancreaticolithiasis Patients After Extracorporeal Shock Wave Lithotripsy in Thailand, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.