Korean J Gastroenterol.  2014 Apr;63(4):231-238. 10.4166/kjg.2014.63.4.231.

Safety and Effectiveness of Successive Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis under Intravenous Bolus Pethidine Administration Alone

• Lee BU
• Kim MH
• Choi JH
• Choi JH
• Kim HJ
• Park DH
• Lee SS
• Seo DW
• Lee SK

• KMID: 1791880
• DOI: http://doi.org/10.4166/kjg.2014.63.4.231

Abstract

BACKGROUND/AIMS
A retrospective analysis was performed to evaluate the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) for pancreatolithiasis on successive days under intravenous bolus of pethidine alone.
METHODS
Ninety patients with calcified pancreatic stones (> or =5 mm) presenting with abdominal pain were selected for ESWL. ESWL was performed with an electroconductive lithotripter under fluoroscopic target systems. Fragmented calculi after ESWL were removed by endotherapy.
RESULTS
A mean of 4.2 ESWL sessions were performed for each patient, with a mean of 2,984 shocks at a mean power setting of 12.8 kV. Eighty-four (89.3%) patients underwent ESWL for three or more days in a row. Fragmentation of the stones were achieved in 83/90 (92.2%) patients. Complete clearance of the main pancreatic duct was achieved in 54/90 (60.0%) patients, and partial clearance was achieved in 27 (30.0%) patients. The mean dose of pethidine used during ESWL was 53.5+/-20.7 mg per session. As ESWL-related complications, four (4.3%) patients developed mild acute pancreatitis.
CONCLUSIONS
In case of endoscopically difficult-to-treat pancreatic duct stones, combined therapy with ESWL is an effective method, and treatment with multiple sessions of ESWL on successive days under intravenous bolus of pethidine alone is safe and well tolerated.

Keyword

Calculi; Pancreatic ducts; Extracorporeal shockwave lithotripsy

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Calculi/*therapy
Female
Fluoroscopy
Humans
Injections, Intravenous
*Lithotripsy
Male
Meperidine/*administration & dosage
Middle Aged
Pancreatic Ducts
Pancreatitis/therapy
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Meperidine

Figure

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  Fig. 1. (A, B) During extracorporeal shock wave lithotripsy, the patient lies on the lithotripter table in the prone position. (C) Fluoroscopy image shows a targeted stone (arrow).

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  Fig. 2. Extracorporeal shock wave lithotripsy (ESWL) sessions provided during the same admission period in an individual patient.

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  Fig. 3. (A-C) Pre-extracorporeal shock wave lithotripsy (ESWL); (A, B) Abdominal CT and MRCP show an impacted pancreatic stone (arrow) with upstream duct dilatation. (C) ERCP reveals a partially opacified main pancreatic duct with contrast injection. However, the guidewire failed to advance beyond the impacted stone (arrow) into the upstream duct. (D, E) Post-ESWL; (D) Fragmented pancreatic duct stones by ESWL were removed by balloon catheter during ERCP. (E) Follow-up pancreatogram shows no residual pancreatolithiasis in the main pancreatic duct.

Reference

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