Pancreatic stone treatment with endoscopic ultrasonography-guided antegrade treatment and extracorporeal shock wave lithotripsy

Abstract

A 68-year-old man presented with a history of Billroth II gastrectomy for duodenal ulcer. A follow-up CT scan for alcoholic chronic pancreatitis revealed a pancreatic stone in the main pancreatic duct (MPD) of the pancreatic head and upstream ductal dilation. Therefore, endoscopic treatment in combination with extracorporeal shock wave lithotripsy (ESWL) was selected. The reconstructed intestine was expected to be difficult to approach by the transpapillary procedure. Hence, endoscopic ultrasonography-guided antegrade treatment (EUS-AG) was implemented. First, an endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) was performed, and a plastic stent was placed in the MPD and the stomach. ESWL was performed after the formation of gastro-pancreatic duct fistula. ESWL was administered to fragment the stone. The stones were then removed using EUS-AG. No procedure-related adverse events were observed. Using EUS-AG for treating pancreatic stone diseases that are difficult to approach by the transpapillary procedure may be a useful alternative.