Introduction Chronic calcific pancreatitis is associated with the development of pancreatic ductal calculi. The calculi can lead to the blockage of the pancreatic duct which can increase the pressure in the duct causing pain. Removal of pancreatic calculi is conventionally done using endoscopic retrograde cholangio-pancreatiocography (ERCP). However, removal of large pancreatic calculi may not be amenable using ERCP alone. External shockwave lithotripsy has been successfully used to target and fragment large calculi located in the head or body of the pancreas. The fragmented calculi can be extracted by subsequent ERCP.
Methods We conducted a retrospective case-control study. We identified a cohort of patients who underwent ESWL followed by ERCP for the clearance of large calculi in the pancreatic duct and a cohort who were treated conventionally with ERCP +/- pancreatic duct stenting over a 15-month period from 22 August 2012 to 21 November 2013 in a tertiary hepatopancreatobiliary centre. The medical notes, endoscopy reports and radiological imaging of these patients were reviewed retrospectively to assess the success of achieving ductal clearance and the improvement in abdominal pain.
Results We identified 9 patients who underwent ESWL followed by ERCP and a same number of matched controls. Complete ductal clearance following ESWL/ERCP was 6 (66.7%) and partial in 3 (33.3%). 1 patient required 2 sessions of ESWL. Following ESWL/ERCP, 4 (44%) patients had no pain, 4(44%) had mild to moderate pain and 1 had severe pain. In the control group, 2 had no pain, 2 had mild to moderate pain and the rest still experienced severe pain. There were no complications following ESWL.
Conclusion ESWL combined with ERCP is safe and efficient in providing symptomatic relief for patients with large pancreatic calculi related to chronic pancreatitis. It can be offered as first line therapy in select patients with large pancreatic calculi.
References 1 Tandan M, Reddy DN, Santosh D, Reddy V, Koppuju V, Lakhtakia S, Gupta R, Ramchandani M, Rao GV. Extracorporeal shock wave lithotripsy of large difficult common bile duct stones: efficacy and analysis of factors that favor stone fragmentation. J Gastroenterol Hepatol 2009:24:1370–1374
2 Ellis RD, Jenkins AP, Thompson RP, Ede RJ. Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy. Gut 2000:47:728–731
3 Lawrence C, Siddiqi MF, Hamilton JN, Keane TE, Romagnuolo J, Hawes RH, Cotton PB. Chronic calcific pancreatitis: combination ERCP and extracorporeal shock wave lithotripsy for pancreatic duct stones. South Med J 2010 Jun;103(6):505–8
Disclosure of Interest None Declared.
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