Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience.
OBJECTIVE
Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP.


METHODS
Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal.


CONCLUSIONS
ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.
Tandan
Manu
M
Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad 500082, India. aigindiainfo@yahoo.co.in
Reddy
Duvvuru Nageshwar
DN
Santosh
Darisetty
D
Vinod
Koppoju
K
Ramchandani
Mohan
M
Rajesh
Gupta
G
Rama
Kotla
K
Lakhtakia
Sandeep
S
Banerjee
Rupa
R
Pratap
Nitesh
N
Venkat Rao
Guduru
G
D000328:Adult; D002137:Calculi / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D007194:India; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000209:etiology / Q000628:therapy*; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000150:complications*; D011446:Prospective Studies; D055815:Young Adult