Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis

The aim of our study was to evaluate the long-term results of endoscopic pancreatic stone removal in patients with chronic pancreatitis.

We retrospectively included 53 patients with chronic pancreatitis, in whom an attempt was made at endoscopic stone removal between 1984 and 1993. Patients presented with pain (30) or an exacerbation of pancreatitis (23). A sphincterotomy was performed in 41 patients. A nasopancreatic drain was left in situ for saline flushing in 6 patients. A pancreatic stent was inserted beyond the stones in 28 patients. Fragmentation of stones was performed by mechanical lithotripsy in 4 patients or by extracorporeal shock wave lithotripsy in 8 patients.

All patients had pancreatic stones (multiple 33, single 20) with proximal dilatation of the pancreatic duct. Median follow-up was 33 months (range 4 to 131). Stone removal was successful in 42 patients (79%) (complete 39, partial 3) with relief of symptoms in 38 of 42 (90%). The remaining 4 patients had pancreatic surgery. Stone removal failed in 11 patients and 3 of 11 patients had symptomatic improvement. The remaining 8 patients needed either pancreatic surgery (4) or continued conservative treatment (4). Thirteen of the 53 patients (25%) had recurrent stones, which could be removed endoscopically in 10 of 13. Procedure-related complications occurred in 5 of 53 patients (9%). Mortality was 0%. Seven of the 28 stented patients (25%) had stent-related complications.

Endoscopic treatment of pancreatic stones is a valid approach in patients with pancreatic lithiasis with an acceptable risk profile.