Use of intravenous secretin during extracorporeal shock wave lithotripsy to facilitate endoscopic clearance of pancreatic duct stones

Abstract

Background/aims: Pancreatic duct calcifications are common in chronic pancreatitis. Secretin (SEC) stimulates pancreas duct cells to secrete bicarbonate-rich fluid. SEC may aid fragmentation and facilitate excretion of pulverized pancreatic stones during extracorporeal shock wave lithotripsy (ESWL). The aim was to evaluate the effect of SEC administered during ESWL on clearance of main pancreatic stone (MPDS) at endoscopic retrograde cholangiopancreatography (ERCP).

Methods: Between Jan. 2003 and Sept. 2010, patients with MPDS who were treated with ESWL and ERCP were identified retrospectively. The number and diameter of calcifications were assessed at pre-ESWL images. Before 2006, ESWL was performed without SEC stimulation. From 2007, 16 μg of SEC was administered IV near the beginning of ESWL at the discretion of the managing physician. Clearance of the pancreatic duct was assessed with ERCP after ESWL.

Results: A total of 233 consecutive cases (SEC group: 71, no SEC group: 162) were tallied. Overall there were 310 ESWLs and 332 ERCPs in the 233 cases. On univariate analysis, the use of SEC showed significantly higher rate of complete MPDS clearance (63% vs. 46%, p = 0.021) after first ESWL/ERCP. The number of repeat sessions of ESWL/ERCP was similar between the two groups (SEC vs. No SEC, ESWL/ERCP: 1.27 vs. 1.36/1.34 vs. 1.46). Independent predictors of complete/nearly complete stone clearance included the use of SEC (p = 0.005), pre-ESWL pancreatic stent (p = 0.001).

Conclusions: Secretin during ESWL appears to aid clearance of MPDS in chronic calcific pancreatitis. Further prospective randomized studies would be of interest.