Reply to Rerknimitr

We appreciate the insights from Dr Rerknimitr [1]. We would like to highlight that our study was prospective in nature and aimed to identify the baseline characteristics that can predict persistent pain in patients with chronic calcific pancreatitis who undergo extracorporeal shockwave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) [2]. As mentioned, we excluded patients with multiple pancreatic duct (PD) strictures. Out of 93 patients with PD strictures, 14 had refractory PD strictures. PD stricture was identified as a predictor of persistent pain, and these patients require further management depending on stricture morphology.

In India, patients with chronic pancreatitis typically have large pancreatic stones, which are dense and spiculated. Our practice of combined ERCP with ESWL is in alignment with a recently published randomized controlled trial (RCT) [3]. In addition, the current guidelines consider the recommendation of restricting the use of endotherapy after ESWL for patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL as a weak recommendation [4]. We are currently working on an RCT to compare combined ESWL and endotherapy versus ESWL alone, to establish high-level evidence.

Publikationsverlauf

Eingereicht: 03. August 2024

Angenommen: 14. August 2024

Artikel online veröffentlicht:
28. Januar 2025

• References

• 1 Rerknimitr R. The necessity of therapeutic ERCP after extracorporeal shockwave lithotripsy in chronic calcific pancreatitis. Endoscopy 2024; 56.
• 2 Gurav N, Jagtap N, Koppoju V. et al. Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis. Endoscopy 2024; 56: 406-411
• 3 Talukdar R, Olesen SS, Unnisa M. et al. Extracorporeal shock-wave lithotripsy and endoscopy for the treatment of pain in chronic pancreatitis: a sham-controlled, randomized trial. Ann Intern Med 2024; 177: 749-758
• 4 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – updated August 2018. Endoscopy 2019; 51: 179-193