Oral Litholysis in Patients with Chronic Calcific Pancreatitis Unresponsive to or Ineligible for Extracorporeal Shock Wave Lithotripsy and Endoscopic Therapy

• Published in: Digestion Vol. 100; no. 1; p. 55
• Main Authors: Hamano, Koichi, Noda, Aiji, Ibuki, Eri, Ashizawa, Nobuo, Inamoto, Shunsuke, Izumi, Junko, Usami, Jun, Nakagawa, Hiroaki, Wakita, Yoshinori, Maekawa, Masato
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2019
• Subjects: Administration, Oral; Adult; Aged; Calcium Carbonate - chemistry; Calculi - chemistry; Calculi - etiology; Calculi - therapy; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Magnetic Resonance; Female; Humans; Lithotripsy - adverse effects; Male; Middle Aged; Pancreatic Ducts - diagnostic imaging; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - diagnostic imaging; Pancreatitis, Chronic - therapy; Recurrence; Treatment Outcome; Trimethadione - administration & dosage; Trimethadione - adverse effects; Body mass index; Endoscopic therapy; Trimethadione; Extracorporeal shock wave lithotripsy; Oral litholytic therapy; Hemoglobin A1c; Plasma glucose; Dimethadione; Pancreatic stones
• ISSN: 1421-9867
• DOI: 10.1159/000495608

Our study aimed to evaluate the effect of oral litholysis in patients with chronic calcific pancreatitis (CCP) unresponsive to or ineligible for extracorporeal shock wave lithotripsy (ESWL) and endoscopic therapy.
Trimethadione, an antiepileptic agent, was administered orally at a dose of 0.6-0.9 g/day to 15 patients with this condition. Treatment outcome was evaluated by assessment of dissolution of the pancreatic stones on plain X-ray films and computed tomography scans of the upper abdomen. Plasma glucose, hemoglobin A1c, and body mass index (BMI) were also monitored throughout the therapy.
Litholysis was observed in 13 out of 15 patients (86.7%) and was definite in 10 and partial in 3. Six patients had pancreatitis attacks during the therapy; 5 of whom showed definite litholysis and had only 1 mild attack. Of the 11 patients with normal or impaired glucose tolerance at baseline, none developed diabetes mellitus and all showed litholysis. BMI significantly increased in patients whose pancreatic stones dissolved. There was no vital organ impairment by trimethadione.
Oral litholysis using trimethadione may represent a noninvasive and effective complementary treatment in patients with CCP unresponsive to or ineligible for ESWL and endoscopic therapy.