SHOCKWAVE LITHOTRIPSY OF PANCREATIC DUCT STONES - TECHNICAL AND CLINICAL SUCCESS

Background: Chronic pancreatitis is often complicated by concrements o bstructing the main pancreatic duct. Duct obstruction is discussed as potential mechanism responsible for recurrent and persistent pain. Pat ients and methods: 75 symptomatic patients (15 female, 60 male; 46 +/- 12 years) with stones in the main pancreatic duct (solitary n = 23; m ultiple n = 52) primarily not endoscopically extractable even after sp hincterotomy of the pancreatic orifice were treated by means of a piez oelectric lithotripter (Piezolith 2500). Fragmentation and stone clear ance were documented by ERP. The clinical benefit was evaluated in 35 patients (9 female, 26 male; 45 +/- 12 years) followed up meanwhile fo r more than 12 (29 +/- 14) months. Results: After 3 +/- 2 (1 to 10) ES WL-sessions/patient the concrements were fragmented successfully in 80 % of the patients. Focussing of the stones was achieved sonographicall y (15%), fluoroscopically (45%) or using both imaging techniques (40%) . In total, 61% of the patients became stone free, 44% spontaneously, in further 17% all remaining fragments could be removed endoscopically . In 39% of the patients only a partial extraction was achieved. Sever e complications due to shockwave application did not occur. The majori ty of the patients (stonefree n = 22, remaining fragments n = 13) foll owed up greater than or equal to 12 months kept free of pain (51%) or reported on pain relief (26%). Nine patients developed 13 recurrent ca lculi, which were again treated successfully by interventional measure s in 8/9 patients. Conclusions: The data confirm the value of extracor poreal shockwave lithotripsy as an important tool in the interventiona l therapy of chronic pancreatitis. Even if recurrent calculi may occur , the majority of patients patients will experience at least a medium- term profit by those measures due to pain relief.