title: Chronic calcific pancreatitis: combination ERCP and extracorporeal shock wave lithotripsy for pancreatic duct stones.
abstract: BACKGROUND
  Chronic pancreatitis is commonly associated with debilitating abdominal pain, in part due to pancreatic duct obstruction. Pancreatic stones are often impossible to extract from the duct with endoscopic retrograde cholangiopancreatography alone. Extracorporeal shock wave lithotripsy (ESWL) is commonly used for fragmentation of obstructing nephrolithiasis and has demonstrated effectiveness in management of pancreatic stones. Our aim was to examine the outcomes of the first 30 patients with symptomatic pancreatic stones treated with a combination of ESWL and endoscopic therapies.
  
  
  METHODS
  Patients with symptomatic chronic calcific pancreatitis referred for ESWL (2005-2009) were included. Technical success of ESWL was defined as a) stone fragmentation sufficient to allow extraction of main duct stones at ERCP or b) absence of the targeted main pancreatic duct stones on follow-up radiography. Clinical success of ESWL was defined by Patient Global Impression of Improvement (PGII) score of at least slightly improved.
  
  
  RESULTS
  Thirty patients underwent ESWL. One patient was excluded due to adenocarcinoma. Technical success was achieved in 17/29 (58.6%) patients. 25 (86.2%) patients were available for follow-up (median 35 months, range 3-52 months). Fifteen of twenty-five (60%) patients experienced clinical improvement (10 patients very much improved), but there was no significant reduction in the proportion taking narcotics (50% before vs. 44.4% after ESWL). Pancreatic surgery has been avoided to date in 16 (64%) of the 25 patients.
  
  
  CONCLUSIONS
  A multidisciplinary approach, combining ERCP and ESWL, to painful obstructing pancreatic duct stones provided symptomatic improvement and allowed pancreatic surgery to be avoided in the majority of patients.
authors: Division of Gastroenterology, Medical University of South Carolina, College of Medicine, Charleston, SC 29425-2900, USA. lawrench@musc.edu
authors: Christopher
authors: C
authors: Lawrence
authors: M Faisal
authors: MF
authors: Siddiqi
authors: Jonathan N
authors: JN
authors: Hamilton
authors: Thomas E
authors: TE
authors: Keane
authors: Joseph
authors: J
authors: Romagnuolo
authors: Robert H
authors: RH
authors: Hawes
authors: Peter B
authors: PB
authors: Cotton
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002114:Calcinosis / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003131:Combined Modality Therapy; D004363:Drug Utilization; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000628:therapy*; D010348:Patient Care Team; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid