Complete clearance of painless pancreatic stones with endotherapy prevents the progression of pancreatic parenchyma atrophy in patients with chronic pancreatitis: Multicenter cohort study

Tsukasa Ikeura¹, Ayaka Takaori¹, Kazuhiro Kikuta², Ken Ito³, Tetsuya Takikawa², Takaaki Eguchi⁴, Tadahisa Inoue⁵, Yasuki Hori⁶, Kenji Nakamura⁷, Mamoru Takenaka⁸, Yoshio Sogame⁹, Tadayuki Takagi¹⁰, Nao Fujimori¹¹, Satoshi Yamamoto¹², Akira Nakamura¹³, Toshitaka Sakai¹⁴, Arata Sakai¹⁵, Takashi Tamura¹⁶, Tomotaka Saito¹⁷, Koichi Fujita¹⁸, Atsushi Kanno¹⁹, Kunihiro Hosono²⁰, Keisuke Iwata²¹, Atsushi Irisawa²², Kazuhisa Okamoto²³, Masaki Kuwatani²⁴, Makoto Naganuma¹, Atsushi Masamune², Yoshifumi Takeyama²⁵; Japan Pancreatitis Study Group for CP

Collaborators, Affiliations

Collaborators

Japan Pancreatitis Study Group for CP:
Kensuke Takuma, Naoki Okano, Megumi Takagi, Toshiyuki Morisawa, Rena Kitano, Shunsuke Omoto, Tomohiro Yamazaki, Yutaka Takigawa, Satoki Yamane

Affiliations

¹ Division of Gastroenterology and Hepatology, Kansai Medical University Hospital, Osaka, Japan.
² Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
⁴ Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.
⁵ Department of Gastroenterology, Aichi Medical University, Aichi, Japan.
⁶ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
⁷ Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.
⁸ Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
⁹ Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁰ Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
¹¹ Department of Medicine and Bioregulatory Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
¹² Department of Gastroenterology, Fujita Health University Bantane Hospital, Nagoya, Japan.
¹³ Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
¹⁴ Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, Miyagi, Japan.
¹⁵ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
¹⁶ Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁷ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁸ Department of Gastroenterology and Hepatology, Yodogawa Christian Hospital, Osaka, Japan.
¹⁹ Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
²⁰ Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Kanagawa, Japan.
²¹ Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
²² Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.
²³ Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
²⁴ Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
²⁵ Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.

PMID: 40012465
DOI: 10.1111/den.14998

Multicenter Study

Complete clearance of painless pancreatic stones with endotherapy prevents the progression of pancreatic parenchyma atrophy in patients with chronic pancreatitis: Multicenter cohort study

Tsukasa Ikeura et al. Dig Endosc. 2025 Jun.

. 2025 Jun;37(6):638-650.

doi: 10.1111/den.14998. Epub 2025 Feb 27.

Authors

Collaborators

Japan Pancreatitis Study Group for CP:
Kensuke Takuma, Naoki Okano, Megumi Takagi, Toshiyuki Morisawa, Rena Kitano, Shunsuke Omoto, Tomohiro Yamazaki, Yutaka Takigawa, Satoki Yamane

Affiliations

¹ Division of Gastroenterology and Hepatology, Kansai Medical University Hospital, Osaka, Japan.
² Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
⁴ Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.
⁵ Department of Gastroenterology, Aichi Medical University, Aichi, Japan.
⁶ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
⁷ Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.
⁸ Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
⁹ Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁰ Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
¹¹ Department of Medicine and Bioregulatory Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
¹² Department of Gastroenterology, Fujita Health University Bantane Hospital, Nagoya, Japan.
¹³ Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
¹⁴ Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, Miyagi, Japan.
¹⁵ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
¹⁶ Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁷ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁸ Department of Gastroenterology and Hepatology, Yodogawa Christian Hospital, Osaka, Japan.
¹⁹ Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
²⁰ Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Kanagawa, Japan.
²¹ Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
²² Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.
²³ Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
²⁴ Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
²⁵ Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.

PMID: 40012465
DOI: 10.1111/den.14998

Abstract

Objectives: This retrospective multicenter study aimed to clarify the clinical impact of endotherapy for painless pancreatic duct (PD) stones compared with that in patients who received conservative treatment without endotherapy.

Methods: We enrolled 268 patients suffering from chronic pancreatitis with painless PD stones (145 with endotherapy and 123 without endotherapy) and evaluated the impact of endotherapy for painless PD stones on clinical and radiological outcomes.

Results: When conservative treatment without endotherapy was set as a reference, complete clearance of the targeted PD stones decreased the relative risk for atrophy of pancreatic parenchyma after inclusion (hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.21-0.84). Incomplete clearance of the targeted PD stones was identified as a risk factor for new-onset or worsening of diabetes (HR 2.08; 95% CI 1.10-3.91) and inducement of pain attack (HR 4.03; 95% CI 1.45-11.19), although complete clearance was not correlated with these outcomes.

Conclusion: In chronic pancreatitis patients with painless PD stones, endotherapy with complete stone clearance allows the maintenance of pancreatic parenchymal volume. However, if complete clearance fails, endotherapy could lead to aggravation of glucose tolerance and pain attacks during follow-up.

Keywords: chronic pancreatitis; endoscopic retrograde cholangiopancreatography; endotherapy; extracorporeal shock wave lithotripsy; painless pancreatic stone.

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References

REFERENCES

1. Lankisch PG. Natural course of chronic pancreatitis. Pancreatology 2001; 1: 3–14.
1. Di Sebastiano P, di Mola FF, Bockman DE, Friess H, Büchler MW. Chronic pancreatitis: The perspective of pain generation by neuroimmune interaction. Gut 2003; 52: 907–911.
1. Ito K, Takuma K, Okano N et al. Current status and future perspectives for endoscopic treatment of local complications in chronic pancreatitis. Dig Endosc Published online: 4 Oct 2024; DOI:10.1111/den.14926
1. Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: A review. JAMA 2019; 322: 2422–2434.
1. Kitano M, Gress TM, Garg PK et al. International consensus guidelines on interventional endoscopy in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020; 20: 1045–1055.

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Complete clearance of painless pancreatic stones with endotherapy prevents the progression of pancreatic parenchyma atrophy in patients with chronic pancreatitis: Multicenter cohort study

Collaborators

Affiliations

Complete clearance of painless pancreatic stones with endotherapy prevents the progression of pancreatic parenchyma atrophy in patients with chronic pancreatitis: Multicenter cohort study

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources