[Extracorporeal shock wave lithotripsy of pancreatic stones as a part of complex endoscopic therapy].
BACKGROUND
The authors report on ESWL treatment of 29 patients suffering from pancreatolithiasis.


METHODS
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.


RESULTS
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.


CONCLUSIONS
The authors conclude that the ESWL treatment of pancreatic stones together with the endotherapy applied is an effective method for painful pancreatolithiasis.
Gyökeres
Tibor
T
Gasztroenterológiai Osztály, MAV Kórház, Budapest. gyokeres@elender.hu
Schwab
Richárd
R
Burai
Mária
M
Petrik
Róbert
R
Páczelt
Ferenc
F
Pap
Akos
A
D000328:Adult; D000368:Aged; D002137:Calculi / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D003131:Combined Modality Therapy; D004724:Endoscopy; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome
Hasnyálmirigy-vezeték-kövek lökéshullám-kezelése, mint a komplex endoszkópos terápia része.