Gut Liver.  2016 Nov;10(6):873-880. 10.5009/gnl15555.

Management of Pancreatic Calculi: An Update

• Tandan M
• Talukdar R
• Reddy DN

• KMID: 2412091
• DOI: http://doi.org/10.5009/gnl15555

Abstract

Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.

Keyword

Chronic, pancreatitis; Pancreatic calculi; Cholangiopancreatography, endoscopic retrograde; Extracorporeal shockwave lithotripsy

MeSH Terms

Calculi/pathology/therapy
Cholangiopancreatography, Endoscopic Retrograde/*methods
Constriction, Pathologic/surgery
Humans
Lithotripsy/*methods
Pancreas/surgery
Pancreatic Ducts/pathology/surgery
Pancreatitis, Chronic/pathology/*therapy
Sphincterotomy, Endoscopic/*methods
Treatment Outcome