[Extracorporeal shock wave lithotripsy of pancreatic stones as a part of complex endoscopic therapy]

The authors report on ESWL treatment of 29 patients suffering from pancreatolithiasis.

The mean age was 46.5 (23-76) years, there were 7 women and 22 men. The etiology of chronic calcifying pancreatitis was alcohol in 24 (82.7%) cases, idiopathic in 3 (10.3%) patients and there was one familiar and one pancreas divisum case. The indication of ESWL was abdominal pain in 27/29 (93.1%) cases. During ERCP pancreatic sphincterotomy was performed and a nasopancreatic catheter was placed for a continuous lavage with isotonic citrate at a rate of 0.5-1 ml/min for a mean of 6 days. The mean number of ESWLs was 2.2.

Fragmentation was achieved in 28/29 (96.5%) patients. There were five (17.5%) complications, fever in three cases, one case of acute relapse of pancreatitis, and one hematuria. The mean number of therapeutic ERCPs was 2.32 (0-7). Overall a complete duct clearance was achieved in 62% (18/29) of the patients, partial clearance in 13.9% (4/29) but the ESWL was unsuccessful in 24.1% (7/29) of the cases. Early pain relief occurred in almost every case (28/29). Twenty four (82.7%) patients were followed for 18.7 (2-33) months. Each patient remained symptom free. The average weight gain was 7.6 kg. The exocrine pancreatic function determined by Lundh test in 7 patients had not improved (11.2 vs. 12.2 pathological value in average). Recurrence of pancreatic duct stones was revealed in four (22.2%) cases among the 18 successfully treated patients after 15 (7-22) months.

The authors conclude that the ESWL treatment of pancreatic stones together with the endotherapy applied is an effective method for painful pancreatolithiasis.