Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study.

Abstract

Extracorporeal shock wave lithotripsy of pancreatic duct stones (largest stone 12 (SD) 6 mm) was performed in 24 patients with abdominal pain and a dilated duct system (main pancreatic duct 10 (3) mm). The procedure was well tolerated in all but two patients, who had a mild pancreatitic attack immediately after lithotripsy. Disintegration of the stones was achieved in 21 patients. This allowed complete clearance of the duct system by an endoscopic approach in 10 (42%) patients and partial clearance in 7 (29%)

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.…”

“…Results equivalent to or better than those discussed have been reported by others (18,19,21,22,26,27) using electrohydraulic or electromagnetic lithotripters with radiographic stone location. Three groups used ultrasonography alone (28,29) or in combination with radiography (24) for targetting pancreatic ductal concrements; freedom from stones and complete freedom from pain were achieved in up to 70% of patients.…”

“…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).…”

Usefulness and safety of Endoscopic Pancreatic Duct Balloon Dilation（EPDBD）for treatment of pancreatic diseases- pancreatic stone, divisum and pseudocyst

“…Excretion rate and symptom disappearance rate results at our hospital were similar but recurrence rate was significantly lower at 5.6%, considered to be an effect of combined EPDBD therapy [13][14][15][16][17][18][19][20][21]. However, some limitation is that the effect is not permanent; negative effects on the pancreatic duct and parenchyma is unknown; not knowing how much air pressure and time is best; and not having specialized tools available [22][23][24][25][26][27][28][29].…”

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].…”