title: Extracorporeal shock wave lithotripsy with a transportable mini-lithotripter and subsequent endoscopic treatment improves clinical outcome in obstructive calcific chronic pancreatitis.
abstract: BACKGROUND
  Extracorporeal shock wave lithotripsy (ESWL) of pancreatic duct stones followed by ERCP with mechanical clearance of the pancreatic duct and subsequent stenting is an established treatment option for chronic calcific pancreatitis.
  
  
  OBJECTIVE
  To test the efficacy of a modified transportable mini-lithotripter for ESWL of pancreatic duct stones.
  
  
  METHODS
  Prospective single-center study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  This study involved 32 patients with obstructive chronic calcific pancreatitis and pain in whom previous endoscopic stone removal and pancreatic duct decompression had failed.
  
  
  METHODS
  ESWL followed by ERCP for stone clearance of the pancreatic duct and mechanical removal of stones or stenting.
  
  
  METHODS
  Endoscopic duct clearance and/or stent insertion, pain and quality-of-life scores.
  
  
  RESULTS
  A median of 4 ESWL sessions (interquartile range 2.75-8.5) with a median of 6800 shock waves (4225-15,425) were required. Pain relief after ESWL only was noted in 24 patients (75.0%), whereas no change in the intensity of pain was reported by 7 patients (21.9%), and pain was worse in 1 patient. All patients underwent ERCP and stent placement, resulting in complete resolution of pain in 17 patients (53.1%) and pain improvement in 28 patients (87.5%). The quality-of-life score was significantly improved after ESWL and endoscopic clearance or stenting in all patients.
  
  
  CONCLUSIONS
  Uncontrolled study.
  
  
  CONCLUSIONS
  ESWL with the mini-lithotripter results in fragmentation of pancreatic duct calculi. ESWL in conjunction with endoscopic clearance of the pancreatic duct and stenting is associated with significant improvement in clinical outcome and quality of life in patients with obstructive calcific chronic pancreatitis.
authors: Department of Medicine, Falkenstein Klinik, Bad Schandau, Germany.
authors: Vladan
authors: V
authors: Milovic
authors: Till
authors: T
authors: Wehrmann
authors: Christoph F
authors: CF
authors: Dietrich
authors: Adam A
authors: AA
authors: Bailey
authors: Wolfgang F
authors: WF
authors: Caspary
authors: Barbara
authors: B
authors: Braden
mesh_terms: D000328:Adult; D000368:Aged; D002137:Calculi / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome