COMBINED-MODALITY TREATMENT OF SYMPTOMATIC PANCREATIC DUCTAL LITHIASIS

Objective: To assess the efficacy acid safety of the removal of pancre atic duct stones by a combined modality approach in patients with panc reatic ductal lithiasis and recurrent abdominal pain. Design: Retrospe ctive review with a mean follow-up of 19 months (range, 1 to 56 months ). Setting: A tertiary care, private community hospital with a univers ity affiliation. Patients: The records of patients who presented to th e hospital or who were referred with recurrent abdominal pain and who were demonstrated to have pancreatic ductal lithiasis between 1989 and 1994 were reviewed. Patients were assessed by their clinical response to pancreatic duct stone extraction by a variety of therapeutic inter ventions. Results: Fifteen patients were included in the study. One pa tient was excluded from analysis because of a concurrent choledochocel e. Two patients required operative decompression and stone extraction for endoscopically inaccessible stones. Six patients were treated with endoscopic management alone, and six were treated with a combination of extracorporeal shock wave lithotripsy and endoscopic stone retrieva l. Twelve patients had complete clearance of the pancreatic duct. One patient had a stone that was not removed, but adequate pancreatic duct al decompression was achieved. The remaining patient had incomplete cl earance of pancreatic stone fragments following extracorporeal shock w ave lithotripsy but had adequate ductal drainage. No patient has requi red further therapy or hospitalization for abdominal pain. No complica tions occurred as a result of any intervention in this study. Conclusi ons: A multidisciplinary combined modality approach is a safe and effe ctive method for extracting pancreatic duct stones in symptomatic pati ents. Stone extraction and reestablishment of adequate ductal drainage appear to relieve symptoms in some patients.