Disintegration of Pancreatic Duct Stones with Extracorporeal Shockwave Lithotripsy in Patients with Chronic Pancreatitis

Lee, Sung Koo; Kim, Myung Hwan; Min, Yong Il; Seo, Dong Wan; Kim, Yeon Suk; Kim, Hing Ja; Myung, Seung Jae; Yang, Soo Hyun; Joo, Kwang Ro; Shim, Ki Nam; Park, Eui Ryun; Kim, Jeong Soo; Kim, Seung Yong; Cho, Jae Chul

Abstract

BACKGROUND AND AIMS: Calculous obstruction of the main pancreatic duct, accompanying upstream dilatation and hypertension, is one of the causes of pain in patients with chronic pancreatitis. Extracorporeal shock wave lithotripsy (ESWL) is useful when the stones cannot be removed by endoscopic pocedures alone. We reviewed our results in 7 patients treated with combined endoscopic-ESWL approach.
METHODS
Between March 1990 and December 1997, seven patients with severe chronic pancreatitis were treated by ESWL for endoscopically umetrievable obstructive stones in our department. For all patients, endoscopic pancreatic sphincterotomy was carried out to facilitate the passage of fragments into the duodenum. Then, the ESWL was performed with an electrohydraulic lithotriptor. Patients were sedated with intravenous injection of 50 mg of pethidine. None of the patients was treated under general anesthesia.
RESULTS
The procedures were well tolerated in all patients. Fragmentation and complete clearance of pancreatic duct stanes were obtained in all 7 patients (100%). The mean number of shock wave treatments was 5 (3-6) and the patients teceived 1,697 (1,500-2,370) shockwave discharges with an energy of 15 kv(14+/-16). There was no mortality related to the procedures. A mild increase in serum amylase levels were observed in 2 patients (33%).
CONCLUSIONS
The ESWL is a safe and effective treatment for endascopically unretrievable panereatic stones in the main pancreatic duct. The ESWL combined with endoscopy could inerease the success rate of nonsurgical removal of pancreatic duct stones in the patients with chronic pancreatitis.