EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR TREATMENT OF PANCREATIC STONES

Abstract

Thirty-one patients (18-67y [mean 52.4y] ; 26 males, 5 females) with pancreatic stone (s) were successfully treated by extracorporeal shock wave lithotripsy (ESWL) between 1990 and 2000. Causes of chronic pancreatitis were alcohol (27), idiopathy (3), and pancreas divisum (1) . Thirteen patients had a single stone, 8 patients from 2 to 5 stones, and 10 patients had more than 5 diffuse stones. One to 14 (average 3.2) lithotripsy sessions were performed and 600 to 24, 565 injections (average 5386) were administered. In 29 of 31 cases (93%) treatment was effective. Complete clearance from the main pancreatic duct was achieved in 19 cases (61%) and partial clearance in 10 (32%) . ESWL achieved complete clearance in 14 of the 20 cases (70%) without endoscopic pancreatic-sphincterotomy (EPST) . Therefore, EPST may not always be necessary. After ESWL, symptoms related to pancreatic stones disappeared in 25 of 27 patients (93%) . The PFD test showed improvement in pancreatic exocrine function in 10 of 13 cases (77%) ; all 10 cases had more than 2 pancreatic stones (p<0.01, Student's t-test) . The 75 g-glucose tolerance test indicated improved endocrine function in only 1 of 11 patients. The major complication of ESWL, resolved by conservative treatment, was subcapsular liver hematoma in one patient. All patients had a minor complication, subcutaneous hematoma in the pathway of shock-waves. Of 25 cases followed from 168 to 3126 days, recurrence was noted in 5 cases (20%) (Kaplan-Meier) . Suspected reasons were continuous drinking and stricture of the main pancreatic duct (MPD) . We conclude that ESWL for pancreatic stones is useful, effective as a repeatable procedure and clinically safe.