• Gulseren Seven, Mitchal A Schreiner, Andrew S Ross, Otto S Lin, Michael Gluck, S Ian Gan, Shayan Irani, John J Brandabur, David Patterson, Christian Kuhr, and Richard Kozarek.
• The Digestive Disease Institute at Virginia Mason, Virginia Mason Medical Center, Seattle, Washington, USA.
• Gastrointest. Endosc. 2012 May 1;75(5):997-1004.e1.

BackgroundMost outcomes data on pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for chronic calcific pancreatitis (CCP) are based on studies with <4 years' follow-up, and U.S. long-term studies are lacking.ObjectiveTo report long-term P-ESWL outcomes for CCP and to assess whether smoking or alcohol use influences P-ESWL outcomes.DesignCross-sectional study, retrospective chart review.SettingVirginia Mason Medical Center, Seattle, Washington.PatientsThis study involved 120 patients who underwent P-ESWL and ERCP for CCP and completed an outcomes questionnaire.InterventionP-ESWL and ERCP, outcomes survey.Main Outcome MeasurementsPain, quality of life, narcotics use, diabetes status, pancreatic enzyme requirement, repeat P-ESWL, repeat ERCP, surgery.ResultsA total of 120 patients underwent P-ESWL followed by ERCP (mean ± standard deviation [SD] follow-up 4.3 [± 3.7] years) and completed a survey. The mean (± SD) before-P-ESWL pain score was 7.9 (± 2.6) compared with 2.9 (± 2.6) after P-ESWL (P < .001). Improved pain was reported by 102 patients (85%); 60 (50%) reported complete pain relief and no narcotic use. The mean (± SD) before-P-ESWL quality-of-life score was 3.7 (± 2.4) compared with 7.3 (± 2.7) after P-ESWL (P < .001). In patients with ≥ 4 years' follow-up, repeat procedures included P-ESWL (29%), ERCP (84%), and surgery (16%). Smokers who quit smoking after P-ESWL had improved narcotic requirements compared with those who continued smoking (95% vs 67%; P = .014), and a trend suggested a decreased need for repeat ERCPs (68% vs 84%; P = .071).LimitationsSingle center, retrospective, recall bias, nonvalidated pain and quality-of-life scales.ConclusionP-ESWL as the initial therapy for CCP may lead to more lifetime procedures; however, partial pain relief in 85%, complete pain relief with no narcotic use in 50%, and avoidance of surgery in 84% of patients may be achieved. Quitting smoking after P-ESWL may improve outcomes.Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

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