Endoscopic Treatment of Pancreatic Calculi

Abstract

Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal.

Laparoscopic pancreatic duct incision and stone removal and T-type tube drainage for pancreatic duct stone: A case report and review of literature

“…On the other hand, endoscopic treatment is considered a less invasive and effective modality despite its limitations for use in all patients. Nevertheless, the combination of endoscopic therapy and ESWL can be regarded as first-line treatment in high-risk patients for surgery or such with relevant indications[ 5 ].…”

Pancreatolithiasis: Does Management Depend on Clinical Manifestations?

“…Importantly, there is a strong association with chronic pancreatitis (CP), which is present in 50–90% of these patients [ 4 ]. However, CP in the long term can be associated with a variety of complications affecting both the pancreas (pancreatic pseudocyst, pancreatitis and pancreatic adenocarcinoma) and the adjacent anatomical structures, causing biliary and duodenal obstruction [ 3 , 5 , 6 ]. Moreover, PC is found in less than 1% of a random sample of the population, mainly in older people, but also in younger people and rarely in children [ 7 , 8 ].…”

Rectally administered indomethacin to prevent post-ESWL-pancreatitis (RIPEP): study protocol for a randomized controlled trial

“…Chronic pancreatitis encompasses a wide range of progressive fibro-inflammatory processes of the exocrine pancreas that eventually lead to damage of the gland, leading to abdominal pain, endocrine (diabetes) and exocrine insufficiency (steatorrhea). Pancreatic duct stones, a common complication of chronic pancreatitis, develop during the natural course of disease and are observed in 90% patients [ 1 ]. Current treatment options include endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL) and surgery.…”

“…Based on previous published studies, major complications were classified into five groups: post-ESWL pancreatitis, bleeding, infection, steinstrasse and perforation [ 6 , 9 ]. It is reported that the rate of post-ESWL pancreatitis ranges from 6.3 to 12.5% [ 1 ]. According to previous data in our center, post-ESWL pancreatitis was the most common complication, with an overall occurrence rate of 6.8% for the first P-ESWL sessions.…”