Extracorporeal Shockwave Lithotripsy for Endoscopically Unretrievable Pancreatic Duct Stones

Kim, Hyun Young; Son, Jeoung Min; Kim, Myung Hwan; Lee, Sung Koo; Seo, Dong Wan; Lee, Sang Soo; Park, Ju Sang; Kim, Ki Rhack; Min, Young Il

Abstract

BACKGROUND/AIMS: Upstream hypertension due to calculous obstruction of the main pancreatic duct is a cause of pain in patients with chronic pancreatitis. Extracorporeal shockwave lithotripsy (ESWL) may be needed when pancreatic duct stones cannot be removed by endoscopic procedure alone. We present the results of ESWL in combination with interventional endoscopy in the treatment of endoscopically unretrievable pancreatic duct stones.
METHODS
Between April 1991 and July 2001, 40 patients were treated with ESWL for endoscopically unretrievable stones. In all patients, ESWL was performed with an electrohydraulic lithotriptor ultrasound focusing system after endoscopic pancreatic sphincterotomy.
RESULTS
The procedure was well tolerated in all patients. The mean session of shockwave treatments was 3.3 (1~5). The patients received 1,856.8 (1,281~2,370) shockwave discharges per session using an mean energy of 15.8 kv (14~18). Fragmentation and clearance of the stones were achieved in 38 patients (95%). In 22 patients (55%), the stones were completely removed. Relief of pain occurred in 25 patients (62.5%).
CONCLUSIONS
ESWL is a safe and effective treatment for endoscopically unretrievable main pancreatic duct stones. ESWL combined with interventional endoscopy can increase the success rate of nonsurgical removal of pancreatic duct stones.