Pancreatitis, Chronic
Conditions
Keywords
Extracorporeal Shock Wave Lithotripsy(ESWL), Chronic pancreatitis, Endoscopic Retrograde Cholangiopancreatography(ERCP), Pancreatic stones
Brief summary
This study aims to determine the optimal timing of endoscopic intervention after extracorporeal shock wave lithotripsy(ESWL) of chronic pancreatitis with pancreatic stones.
Detailed description
Chronic pancreatitis（CP）is a chronic progressive fibro-inflammatory disease of the pancreas induced by a wide range of factors including genetic and environmental elements, with recurrent abdominal pain and pancreatic secretion insufficiency as its major clinical signs. Chronic pancreatitis is not only a tough disease of the gastrointestinal system but also a worldwide medical problem. At present, the MESS (medicine-extracorporeal shock wave lithotripsy-endoscopic retrograde cholangiopancreatography-surgery）formed by changhai hospital in CP diagnosis and treatment is gradually becoming mature, and the clinical effect of this system is obvious. However, there are still some difficulties and knowledge gaps in the clinical treatment of CP. Currently, it is recommended by both domestic and foreign guidelines that ERCP combined with ESWL as the first-line treatment pattern for patients with chronic pancreatitis associate pain. It has previously been observed that ERCP performed less than 2 days after ESWL may be more likely to fail, possibly owing to ESWL-induced edema. However, there is no high-quality research to demonstrate how to choose the most optimal timing of ERCP after ESWL for patients with indications for endoscopic treatment. This prospective, randomized controlled research has therefore aimed to determine the most optimal timing of ERCP after ESWL. Patients with painful chronic pancreatitis and pancreatic stones larger than 5 mm in diameter will be randomly and equally assigned to two groups, which are divided according to the time interval between ESWL and ERCP, including the same day (\< 12 hours) subgroup and the next day ( ≥12 hours) subgroup. The cannulation success rate and stone clearance rate of the pancreatic duct will be assessed in each group to explore the most appropriate timing of ERCP, and then provide an important reference basis for the clinical treatment of chronic pancreatitis.
Interventions
PROCEDUREtime interval between ESWL and ERCP is 12h
The patients received intravenous analgesia before the ESWL. After the last ESWL session, the patients are treated with following ERCP within 12h.
PROCEDUREtime interval between ESWL and ERCP is greater than 12h
The patients received intravenous analgesia before the ESWL. After the last ESWL session, the patients are treated with following ERCP ≥12 h.
DRUGmorphine, buprenorphine, pethidine, tramaldol, metamizole and acetylsalicylacid (Analgesics)
Analgesics administrated include morphine, buprenorphine, pethidine, tramaldol, metamizole and acetylsalicylacid. They will only be administrated as needed.
Sponsors
Changhai Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. symptomatic adult patients diagnosed with chronic pancreatitis and main pancreatic duct positive stones（\>5mm in diameter） 2. no ERCP and ESWL history before the admission 3. provides informed consent
Exclusion criteria
1. suspected to have malignant tumors; 2. history of pancreatic surgery or gastrojejunostomy (Billroth II); 3. with end-stage disease; 4. with contraindications to ESWL or ERCP, such as pregnancy, abdominal aortic aneurysm, etc. 5. acute pancreatitis within 3 days 6. pancreatic ascites
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Successful MPD Cannulation Rates | during ERCP procedure | technical success rate of pancreatic cannulation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Successful clearance of MPD stones | during ERCP procedure | Ductal clearance has been defined as complete, partial, or unsuccessful if the proportion of stones cleared was \> 90 %, 50 %-90 %, or \< 50 %, respectively. |
| post-ERCP complications | 30 days | Major post-ERCP complications includes post-ERCP pancreatitis, bleeding, infection, and perforation, which are classified as mild, moderate, or severe, depending mainly on the length of hospitalization and the need for invasive treatment. |
| severity of post-ERCP complications | 30 days | severity are classified as mild, moderate, or severe, depending mainly on the length of hospitalization and the need for invasive treatment. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Treatment-related costs in RMB from initial enrollment to the end of the study | through endotherapy completion, an average of 14days | The total costs in RMB of each hospitalization |
| The hospitalization time | through endotherapy completion, an average of 14days | Length of hospitalization due to ESWL /ERCP and complications |
Countries
China
Outcome results
None listed