Extracorporeal shock wave lithotripsy for pancreatic stones
- Myriam Delhaye, MD
Myriam Delhaye, MD
- Universite Libre de Bruxelles, Belgium
Treatment of human calculi by extracorporeal shock wave lithotripsy (ESWL) was first used in patients for the treatment of kidney stones in 1980 . Subsequently, this technique has been applied to gallstones  and pancreatic stones . (See "Dissolution therapy for the treatment of gallstones".)
The treatment of pancreatic stones using ESWL will be reviewed here. The treatment of chronic pancreatitis, electrohydraulic lithotripsy, and laser lithotripsy are discussed separately. (See "Treatment of chronic pancreatitis" and "Electrohydraulic lithotripsy in the treatment of bile and pancreatic duct stones" and "Laser lithotripsy for the treatment of gallstones".)
CLINICAL SIGNIFICANCE OF PANCREATIC STONES
Pancreatic duct stones are found in approximately 22 to 60 percent of patients with chronic pancreatitis (CP) . The stones can lead to obstruction of the outflow of pancreatic secretions, causing increased intraductal pressure . Because the pancreas is relatively noncompliant, the rise in intraductal pressure can induce tissue hypertension and ischemia, which may be a major factor causing pain in patients with CP . This hypothesis is supported by the observation that symptoms may improve following pancreatic duct drainage [7,8].
The extraction of pancreatic duct stones has usually been attempted during endoscopic retrograde cholangiopancreatography (ERCP). However, successful stone extraction during ERCP depends upon the size and location of the stones and may not be possible if strictures are present or pancreatic stones have become embedded in the ductal system. As a result, a method of stone disruption prior to endoscopic extraction could be helpful. ESWL leads to the fragmentation of pancreatic stones, which has improved the results of endoscopic therapy and may have additional indications in the treatment of patients with CP .
Lithotripsy works by concentrating focused shock waves (SWs) on stones, which causes their disruption. SWs can be generated by three methods:
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- CLINICAL SIGNIFICANCE OF PANCREATIC STONES
- PATIENT SELECTION
- Stone localization
- Antibiotic prophylaxis
- Application of shock waves
- Need for ERCP
- Technical results
- Clinical results
- - Pain relief
- - Pancreatic endocrine and exocrine function
- - Stone recurrence
- ESWL monotherapy compared to ESWL combined with endoscopic drainage
- Need for surgery
- SUMMARY AND RECOMMENDATIONS