Painless pancreatic stones still need further discussion

Painless pancreatic stones still need further discussionDear Editor, We read with great interest the published study by Ikeura et al., 1 which investigated the impact of endotherapy for painless pancreatic stones.The study is valuable, while we found that some details require further discussion.First, the definitions in this research should be improved.It is well recognized that the painless chronic pancreatitis (CP) patients were those who did not have pain and a previous diagnosis of acute pancreatitis. 2Including painless CP patients only depends on the history of treatment and the use of analgesic drugs, as shown in this research, may incorrectly encompass individuals who experience abdominal pain consistent with CP that does not warrant treatment or necessitate analgesic.In addition, patients with stress hyperglycemia during pancreatitis or after endotherapy and surgery may also be inappropriately identified as exacerbated glucose tolerance, which would not be helpful to clarify the clinical impact of endotherapy. 3Therefore, we suggested considering the 90-day lag period into the evaluation of exacerbated glucose tolerance.Second, as we all know, pancreatic surgery was the definite risk factor for diabetes. 4In this research, three patients in the incomplete clearance group underwent surgery, and their endocrine function had been affected by pancreatic surgery.For this reason, the difference of the rate of exacerbated glucose tolerance between these three groups might be overestimated.Third, the rate of alcoholic CP in table 1 was confusing.According to the clinical diagnostic criteria proposed by the Japan Pancreas Society, patients diagnosed as alcoholic CP consumed alcohol >60 g/day. 5As shown in table 1, only 81 patients consumed alcohol >60 g/day, while 152 patients were diagnosed as alcoholic CP.Any reasonable explanations for this rate should be discussed.In a word, this research has important implications for guiding clinical practice, while the results still need further discussion.