To study the efficacy of extracorporeal shock-wave lithotripsy (ESWL) of pancreatic duct stones, seventeen patients (mean age: 42 years) with recurrent attacks of abdominal pain as a result of chronic calcifying pancreatitis were treated with this method. In all cases, endoscopic removal of the stones proved impossible. When there was fragmentation, the remaining calculi and fragments either evacuated spontaneously, or attempts were made to extract them endoscopically, followed by flushing. In 13 patients (76%), fragmentation of stones was achieved, and 11 of these patients had dramatic pain relief directly after ESWL (65%). However, complete ductal clearance of stones was achieved in only seven patients (41%); at the last follow-up (12-59 months after ESWL, mean: 30 months), all seven were free of symptoms. Of the six patients with stone fragmentation without ductal clearance, three were operated on because of recurrent complaints. The only complication due to the procedure was an exacerbation of pancreatitis in one patient, which was treated conservatively. If pancreatic stones cannot be removed endoscopically, ESWL seems to be preferable to surgery, which may still be performed in case of failure. It seems important to achieve ductal clearance and not merely stone disintegration in order to obtain the desired long-term clinical effects.

Since the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed patients with other patient series, we bave tried to assess this role. We treated 133 patients with cholecystolithiasis, 80 patients with choledocholithiasis, and 17 patients with pancreatic stones using a second-generation lithotriptor, the Siemens Lithostar (Siemens, Erlangen, Germany). The results suggest a limited role of ESWL for cholecystolithiasis, in which it is reserved for patients with high operative risk and patients who reject an operation. For choledocholithiasis ESWL seems to become an integral part of the treatment in the elderly patient in whom endoscopic stone removai proved impossible. Finally, ESWL could become a first option for the treatment of intractable pain in patients with chronic calcifying pancreatitis.Shock waves, which can be used to disintegrate stones because of their physical characteristics, can be generated by three methods [1][2][3]. Since 1980 extracorporeal shock wave lithotripsy (ESWL) has been used in the case of urolithiasis and has replaced surgical treatment almost entirely [4,5]. ESWL of gallbladder stones has been applied since 1985 [6, 7], and the first reports on ESWL of common bile duct stones and pancreatic stones appeared in 1989 [8,9]. Despite the initial enthusiasm, restrictions for ESWL of gallbladder stones especially soon became evident. Rigid entry criteria, expensive adjuvant dissolution therapy, moderate results, and the possibility of stone recurrence after gallbladder-preserving therapies are major drawbacks [7,[10][11][12][13][14][15][16][17]. ESWL of common bile duct stones is useful in patients in whom endoscopic removal proves impossible [8,[18][19][20][21]. ESWL of pancreatic stones in chronic calcifying pancreatitis is still relatively unknown but seems effective [22]. The morbidity and mortality associated with ESWL are minimal [7,8,[11][12][13][18][19][20][21][22] and compare favorably to those with surgery. Therefore we have tried to assess the exact role of ESWL in this field with our own prospectively followed patients and other patient series.