Letter: Assessing the Durability of Treatment Effects: Long-Term Outcomes of ESWL and ERCP for Pancreatic Duct Stones in Chronic Pancreatitis—Authors' Reply

IF 6.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Yu Liu, Liang-Hao Hu
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引用次数: 0

Abstract

We would like to thank Dr. Tang et al. for their insights and comments [1] on our study entitled ‘Long-term Clinical Outcomes of Extracorporeal Shockwave Lithotripsy and Endoscopic Retrograde Cholangiopancreatography for Pancreatic Duct Stone Treatment in Patients with Chronic Pancreatitis’ [2] which reported the efficacies of extracorporeal shockwave lithotripsy for pancreatic stones (P-ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) for painful chronic pancreatitis (CP). As we have stated in the limitation part that pain relief and pain type conversion in patients with CP after P-ESWL and ERCP treatment may be influenced by many confounding factors, several factors like history of pancreatic surgery, presence of pancreatic pseudocysts, may also influence the treatment efficacy. The proportion of patients underwent pancreatic surgery and patients with pancreatic pseudocysts in our study exhibited in table 1 were low which could cause little effects to our study's conclusion [2]. Patients diagnosed with pancreatic cancer within 2 years after diagnosis of ‘CP’ has been excluded from the current study as shown in figure S1; because the initial diagnosis of those patients were misdiagnosed, which ensured the purity of the study population [2, 3]. Patients may develop pancreatic cancer during the long-term disease course of CP which is an important clinical event for CP [4]. Patients with newly diagnosed pancreatic cancer may present distinct pain patterns. However, the results could hardly be affected due to the quite low ratio of these patients. Patients with significant ascites, multiple strictures (chain of lake appearance) and suspicious pancreatic head mass were not eligible for P-ESWL treatment and thus were not included in the study [5].

As it was exhibited in the Methods part, ERCP is performed according to the guideline as much as possible [6]. In most cases, two ERCP procedures after P-ESWL would be performed in each patient in our study. The first ERCP after P-ESWL is for removing the fragmented stones and placing stents if necessary. The second ERCP is for removing pancreatic stents 1 year later. In very rare cases, more ERCPs are performed to solve some difficult problems, like stent detachment and stent displacement. Totally 1929 out of 2071 patients underwent ERCP after P-ESWL treatment. Technique success which was defined as success in stone extraction in the main pancreatic duct was achieved in 86.5% patients in the first ERCP after P-ESWL. For those with failed stone extraction, further surgery rather than repetitive ERCP would be preferred when considering the likelihood of procedural success. Hence, multiple ERCPs were not common in our study. The number of P-ESWLs would cause little influence on the treatment efficacy as the P-ESWL procedures aimed at fragmenting pancreatic stones into smaller pieces < 3 mm. P-ESWL would stop once the goal was achieved. The complication risk of P-ESWL was not a major focus of the current study and it was analysed in detail in the other study [7].

Ultimately, the current study has included adequate potential factors and provided relatively robust evidence for the treatment efficacy of P-ESWL and ERCP for patients with CP.

Yu Liu: conceptualization, writing – original draft, writing – review and editing. Liang-Hao Hu: conceptualization, writing – original draft, writing – review and editing.

The authors declare no conflicts of interest.

This article is linked to Liu et al papers. To view these articles, visit https://doi.org/10.1111/apt.18224 and https://doi.org/10.1111/apt.18321.

信评估治疗效果的持久性:ESWL和ERCP治疗慢性胰腺炎胰管结石的长期疗效--作者的回复。
我们要感谢Tang博士等人对我们题为“体外冲击波碎石术和内镜逆行胆管造影治疗慢性胰腺炎患者胰管结石的长期临床结果”的研究提出的见解和评论,该研究报告了体外冲击波碎石术治疗胰腺结石(P-ESWL)和内镜逆行胆管造影(ERCP)治疗疼痛性慢性胰腺炎(CP)的疗效。正如我们在局限性部分所述,CP患者在P-ESWL和ERCP治疗后的疼痛缓解和疼痛类型转换可能受到许多混杂因素的影响,胰腺手术史、胰腺假性囊肿的存在等几个因素也可能影响治疗效果。表1中我们研究中胰腺手术患者和胰腺假性囊肿患者的比例较低,对我们的研究结论[2]影响不大。在诊断为“CP”后2年内诊断为胰腺癌的患者已被排除在本研究之外,见图S1;因为这些患者的初诊断是误诊的,保证了研究人群的纯洁性[2,3]。在CP的长期病程中,患者可能发展为胰腺癌,这是CP[4]的重要临床事件。新诊断的胰腺癌患者可能表现出明显的疼痛模式。然而,由于这些患者的比例很低,因此几乎不会影响结果。有明显腹水、多发狭窄(湖状链状)和可疑胰头肿块的患者不适合P-ESWL治疗,因此未纳入研究bbb。正如方法部分所展示的那样,ERCP是尽可能根据指南执行的。在大多数情况下,在我们的研究中,每个患者在P-ESWL后会进行两次ERCP手术。P-ESWL后的第一次ERCP是为了清除碎片性结石,必要时放置支架。第二次ERCP是用于1年后移除胰腺支架。在非常罕见的情况下,更多的ercp是为了解决一些难题,如支架脱离和支架移位。2071例患者中有1929例在P-ESWL治疗后接受ERCP。86.5%的患者在P-ESWL后的第一次ERCP中获得了技术成功,其定义为主胰管结石取出成功。对于结石取出失败的患者,考虑到手术成功的可能性,进一步手术比重复ERCP更可取。因此,在我们的研究中,多个ercp并不常见。P-ESWL的数量对治疗效果影响不大,因为P-ESWL的目的是将胰腺结石分割成3毫米的小块。一旦目标实现,P-ESWL就会停止。P-ESWL的并发症风险并不是本研究的主要焦点,在其他研究bbb中有详细的分析。最终,本研究纳入了足够的潜在因素,并为P-ESWL和ERCP对cp患者的治疗效果提供了相对有力的证据。yu Liu:构思,写作-原稿,写作-审查和编辑。胡良浩:构思、撰写原稿、撰写审稿、编辑。作者声明无利益冲突。本文链接至Liu等人的论文。要查看这些文章,请访问https://doi.org/10.1111/apt.18224和https://doi.org/10.1111/apt.18321。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
15.60
自引率
7.90%
发文量
527
审稿时长
3-6 weeks
期刊介绍: Alimentary Pharmacology & Therapeutics is a global pharmacology journal focused on the impact of drugs on the human gastrointestinal and hepato-biliary systems. It covers a diverse range of topics, often with immediate clinical relevance to its readership.
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