title: Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience.
abstract: 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.
authors: Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad 500082, India. aigindiainfo@yahoo.co.in
authors: Manu
authors: M
authors: Tandan
authors: Duvvuru Nageshwar
authors: DN
authors: Reddy
authors: Darisetty
authors: D
authors: Santosh
authors: Koppoju
authors: K
authors: Vinod
authors: Mohan
authors: M
authors: Ramchandani
authors: Gupta
authors: G
authors: Rajesh
authors: Kotla
authors: K
authors: Rama
authors: Sandeep
authors: S
authors: Lakhtakia
authors: Rupa
authors: R
authors: Banerjee
authors: Nitesh
authors: N
authors: Pratap
authors: Guduru
authors: G
authors: Venkat Rao
mesh_terms: 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