Extracorporeal shock wave lithotripsy of pancreatic duct stones and patient factors related to stone disintegration

Abstract

We may consider the application of ESWL therapies for patients who show the factors associated with easily disintegratable stone conditions. These therapies are highly effective and relatively safe procedures for pancreatic duct stones in such patients.

Italian consensus guidelines for chronic pancreatitis

“…Transabdominal US is able to confirm the diagnosis of advanced chronic pancreatitis, since it identifies the thinning of the pancreatic parenchyma, the irregularity of the pancreatic margins, dilatation of the main pancreatic duct and of the side branches, and endoductal calcified stones [114][115][116]. Transabdominal US is not able to depict early chronic pancreatitis, since it does not recognize parenchymal and ductal changes indicative of the early phase of chronic pancreatitis [114,[117][118][119][120][121][122][123][124][125][126][127].…”

“…ESWL overcomes the problem of the stone size by fragmenting the stones, thus facilitating endoscopic clearance of the duct. ESWL is required in 36−68% of patients and successful rates of stone clearance of the main pancreatic duct ranged from 37% to 100% [115,120,173,[179][180][181][182][183][184][185][186][187]. Use of ultrasound instead of x-rays to locate pancreatic stones is associated with a lower fragmentation rate [188,189].…”

Chronic pancreatitis

“…6). Therapeutic measures such as stenting and lithotripsy can relieve abdominal pain for a period of time but are unable to prevent or postpone the development exocrine pancreatic insufficiency [98,99]. Taken together with the above-described animal models of chronic pancreatitis, these observations clearly indicate that chronic pancreatitis diagnosed by the abnormalities of pancreatic duct system is irreversible.…”

ERCP in Chronic Pancreatitis

“…Success rates of pulverization of pancreatic stones using ESWL range between 38 and 100 %, [18], and ESWL alone can provide significant pain relief [19][20][21]. However, ESWL followed by ERCP has been shown to achieve the most satisfactory pain relief in patients with chronic calcific pancreatitis.…”