Computed tomography prediction of pancreatic extracorporeal shockwave lithotripsy outcomes could be improved

摘要

To the Editor: We read with great interest the paper of Liu et al., Noncontrast computed tomography factors predictive of extracorporeal shock wave lithotripsy outcomes in patients with pancreatic duct stones [1]. They found that noncontrast computed tomography (CT) parameters could predict extracorporeal shock wave lithotripsy (ESWL) outcomes in patients with pancreatic duct stones. However, we have some different views about this study. Pancreatic ESWL is a minimally invasive, effective, and safe therapy for the management of pancreatic stones. The target population for ESWL is patients with painful chronic pancreatitis and radiopaque stones of > 5 mm in diameter. For each individual patient, the ESWL session is repeated until the stone was fragmented to < 2-3 mm in diameter, mostly followed by stone extraction using endoscopic retrograde cholangiopan-creatography (ERCP) [2]. ERCP is an important but not essential step during therapy and whether it should be done depends on the specific situation of patients. According to studies conducted by the endoscopy center of the authors' institution, pancreatic stones were usually endoscopically removed by ERCP after ESWL to achieve complete stone clearance [3, 4]. However, when stones were spontaneously cleared, ERCP would not be necessary [5].