title: Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones.
abstract: OBJECTIVE
  We performed extracorporeal shock wave lithotripsy (ESWL) as the treatment of first choice on 32 chronic pancreatitis patients with main pancreatic duct (MPD) stones prospectively to establish more convenient and safer treatment.
  
  
  METHODS
  All patients were treated in a prone position, and shock waves were discharged from the ventral side. ESWL was performed once or twice a week, and no other treatments before ESWL had been applied.
  
  
  RESULTS
  Disintegration of all MPD stones to 3 mm or less in diameter could be achieved in all treated patients. Complete clearance of the stones was obtained in 24 patients (75%) without the necessity of endoscopic extraction of fragments. Reduction of MPD diameters after ESWL was statistically significant (p < 0.01). Epigastric and/or back pain complaints before ESWL were completely alleviated in 79% (periods of follow-up: 16-63 months, mean 44), and the pancreatic exocrine function also improved in 61%. No severe complications occurred in any of the patients.
  
  
  CONCLUSIONS
  ESWL, which is comparatively easy to perform, is a safe and efficient approach that changes endoscopy's status as an indispensable pretreatment. Therefore, ESWL can be recommended as the first choice treatment for patients with chronic pancreatitis accompanied by MPD stones that should be tried before consideration of either surgical or endoscopic procedures.
authors.affiliation: First Department of Internal Medicine, Nagoya City University Medical School, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ohara
authors.forename: M
authors.initials: M
authors.lastname: Hoshino
authors.forename: T
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Y
authors.initials: Y
authors.lastname: Kamiya
authors.forename: M
authors.initials: M
authors.lastname: Miyaji
authors.forename: T
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Okayama
authors.forename: K
authors.initials: K
authors.lastname: Gotoh
mesh_terms: D000328:Adult; D000368:Aged; D002137:Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000628:therapy; D011446:Prospective Studies; D011859:Radiography