Combined Extracorporeal Shock Wave Lithotripsy and Endoscopic Retrograde Pancreatography for Painful Chronic Pancreatitis: Is It Effective?

Abstract Management of pain in chronic pancreatitis (CP) is challenging, and surgery used to be the intervention of choice in patients having pain refractory to medical therapy. Advancement in minimally invasive interventions resulted in a paradigm shift in the management of pain in CP. Pancreatic endotherapy is currently considered the intervention of choice for the management of ductal hypertension in CP. However, multiple mechanisms including ductal hypertension and neurogenic as well as psychological factors contribute to the causation of pain in CP and therefore no single intervention is effective in all patients. The precise role of interventional procedure in a complex disease like CP with multiple pathogenic mechanisms requires a prospective comparative study with a sham group and there are no such comparative studies in the literature. In this news and views, we discuss a recently published sham-controlled randomized trial (Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE) trial) that examined the efficacy of extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) compared with the sham procedure.