INDICATION AND TECHNICAL TIPS FOR ENDOSCOPIC PANCREATIC STONE LITHOTOMY (WITH VIDEOS)

Abstract

The presence of a pancreatic stone in the main pancreatic duct (MPD) may cause pain due to pancreatic stasis or increased MPD pressure. Pancreatic stone lithotomy is a suitable treatment for pain relief and prevents acute exacerbation of pancreatitis. Indications for endoscopic pancreatic stone lithotomy are the presence of a pancreatic duct stone in the Santorini duct or Wirsung duct with abdominal symptoms. Younger patients in whom pancreatic function is expected to be preserved by removing pancreatic stones are also candidates for endoscopic pancreatic lithotomy. Basket extraction and balloon removal are the first choices of treatment in cases of small stones (≦5mm). For stones with a size greater than 5mm, extracorporeal shock wave lithotripsy (ESWL) was preferentially performed before endoscopic lithotomy. Pancreatic stone often coexists with MPD stricture, which requires MPD dilation procedures and pancreatic stent placements. The endoscopic pancreatic stone lithotomy procedure requires proficient knowledge and trouble-shooting techniques to avoid serious complications such as basket impaction, hemorrhage, and perforation. It is also necessary to know the appropriate timing of the endoscopic treatment, and not to miss the timing so that surgical treatment can be avoided.