2021 Volume 36 Issue 4 Pages 274-280
A 77-year-old man with chronic alcoholic pancreatitis presented with abdominal pain. Computed tomography scan revealed a stone in the pancreatic head with a subhepatic fluid collection. Endoscopic retrograde pancreatography was performed for drainage of the main pancreatic duct (MPD); however, the guidewire and catheter could not pass beyond the pancreatic stone. Endoscopic ultrasonographically guided pancreatic duct drainage (EUS-PD) was performed, and a plastic stent was placed in the MPD and the stomach. Extracorporeal shock wave lithotripsy (ESWL) was performed 10 days after EUS-PD. The pancreatic stone disappeared after ESWL. Two months later, the plastic stent was removed, and endoscopic pancreatic sphincterotomy was performed using the EUS-PD rendezvous method. No recurrent pancreatic stones or obstructive pancreatitis was observed during more than 1-year follow-up. ESWL after EUS-PD may be feasible for the removal of therapeutically challenging trans-papillary pancreatic stones.
