Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis.

Aims ESGE suggests ESWL and/or ERCP as first-line therapy for painful uncomplicated chronic pancreatitis(CP) with an obstructed main pancreatic duct in the head/body of the pancreas. However, predictors of pain relief after ESWL are unknown. We aimed to evaluate the independent predictors of persistent pain in patients with CP after ESWL. Methods A total of 640 consecutive adult patients of CP, who underwent successful ESWL and ERCP and PD stent placement were followed for 12 months. The pain was assessed at baseline and at 12 month using Izbicki pain score. Izbicki score decrease at 12 months by >50% is considered as pain relief. The independent predictors of pain relief were derived from logistic regression analysis. Results Of 640 patients (mean age(SD) 36.71 (12.19) years, 60.5% men), 436(68.13%) had pain relief while remaining 204(31.87%) had persistent pain. On univariate analysis older age, male gender, alcohol and tobacco intake, longer duration of symptoms, dilated MPD and MPD stricture were associated persistent pain at 12 months (p < 0.05). Consumption of alcohol (OR - 1.93; 95%CI 1.26 - 2.97); tobacco (OR - 4.09; 95%CI 2.43-6.90); duration of symptoms (OR - 1.02; 95%CI 1.01-1.04); MPD size (OR 1.22; 95%CI 1.11-1.33) and MPD stricture (OR 8.50, 95%CI 5.01-14.42) were independent predictors of persistent pain. Conclusions Alcohol, tobacco, duration of symptoms, dilated MPD and MPD stricture are independent predictors of persistent pain after successful ESWL. A multidisciplinary team approach which includes behavioral therapy and surgical options should be considered in such patients.