title: Efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy, and additional electrohydraulic lithotripsy using the SpyGlass direct visualization system or X-ray guided EHL as needed, for pancreatic lithiasis.
abstract: BACKGROUND
  To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis.
  
  
  METHODS
  For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options.
  
  
  RESULTS
  Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003).
  
  
  CONCLUSIONS
  In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ito
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Okano
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Mimura
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Yui
authors.initials: Y
authors.lastname: Kishimoto
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hara
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takuma
mesh_terms: D000328:Adult; D000368:Aged; D002137:Calculi / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020347:Lithiasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography; D016896:Treatment Outcome; D014965:X-Rays