title: A minimally invasive alternative for managing large pancreatic duct stones using a modified expandable metal mesh stent.
abstract: OBJECTIVE
  Endoscopic clearance of large or impacted stones in the main pancreatic duct (MPD) remains a clinical challenge. In this study, we attempted to technically modify the metallic stent to facilitate the clearance of large pancreatic stones in 4 patients, hoping to lower the operative risks and shorten hospital stay.
  
  
  METHODS
  Four patients with chronic pancreatitis and large stones in the MPD received endoscopic treatment. Inclusion criteria were: (1) pancreatic intraductal stones (number >3; diameter >or=10 mm) and strictures identified in the distal MPD; (2) calculi mainly located in the head, neck and/or body of the pancreas, and (3) failed clearance of stones using a balloon catheter or Dormia basket. Before clearing the pancreatic calculi completely, a technically modified uncovered self-expandable metallic pancreatic stent was implanted in the MPD for 4-7 days to dilate the ductal stenosis, and then drawn out through the working channel.
  
  
  RESULTS
  As the MPD had been sufficiently expanded by the stent, the calculi were removed completely and uneventfully by the balloon or Dormia basket in all 4 patients, without inducing major postoperative complications. A 9- to 15-month follow-up did not find major complications or recurrence of large calculi in the MPD.
  
  
  CONCLUSIONS
  Technically modified metallic stenting is a minimally invasive and clinically feasible alternative to extracorporeal shock wave lithotripsy in the management of large pancreatic duct stones.
authors.affiliation: Department of Gastroenterology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiu-Jiang
authors.initials: XJ
authors.lastname: Yang
authors.forename: Yong
authors.initials: Y
authors.lastname: Lin
authors.forename: Xin
authors.initials: X
authors.lastname: Zeng
authors.forename: Jian
authors.initials: J
authors.lastname: Shi
authors.forename: Yue-Xiang
authors.initials: YX
authors.lastname: Chen
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Shen
authors.forename: Wei-Fen
authors.initials: WF
authors.lastname: Xie
mesh_terms: D002137:Calculi / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010182:Pancreatic Diseases / Q000628:therapy*; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000628:therapy*; D015607:Stents