Extracorporeal Shock-Wave Lithotripsy of Pancreatic Duct Stones: Immediate and Long-Term Results

Abstract

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.

Ultrasound-Guided Extracorporeal Shock Wave Lithotripsy of Pancreatic Ductal Stones: Six Years’ Experience

“…Our complication rate was low, which is similar to results from other groups (18,19,(21)(22)(23)(24)(26)(27)(28)(29). In close temporal association with ESWL we observed mainly mild episodes of pancreatitis.…”

“…Endoscopic procedures involving division of the pancreatic sphincter and extraction of ductal stones are often unsuccessful due to the incongruity between the size of the stone and the anatomy of the pancreatic duct. Stone fragmentation by ESWL permits clearance of the duct by spontaneous passage or endoscopic extraction of stone fragments (11,12,(17)(18)(19)(20)(21)(22)(23)(24).…”

Italian consensus guidelines for chronic pancreatitis

“…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].…”

Current status of endotherapy for chronic pancreatitis

“…Occasionally, exacerbation of pancreatitis also occurs. (20) Conservative management usually leads to resolution. Other reported complications include biliary or pancreatic sepsis, pancreatic fluid collection formation and gastric submucosal haematoma.…”