PIEZOELECTRIC SHOCK-WAVE LITHOTRIPSY OF PANCREATIC DUCT STONES

Objectives: The efficacy of extracorporeal piezoelectric shock wave li thotripsy in patients with obstructing pancreatic duct stones was inve stigated. Methods: Fifty patients suffering from chronic pancreatitis and obstructing pancreatolithiasis were treated by ESWL (Piezolith 250 0). Shock wave treatment was administered, inasmuch as the stones were not extractable by initially applied endoscopic measures. Results: A total of 119 (2.4 +/- 1.4, range 1-7) lithotripsy sessions were conduc ted; only mild sedation/analgesia was used. Optimum targeting of the c oncrements in the shock wave focus was achieved in 17 (14%) treatment sessions with ultrasonography only; it was achieved in 65 (55%) cases by fluoroscopy and, in further 37 (31%) sessions by using both localiz ation systems. Stone fragmentation was successful in 43 (86%) patients . Nineteen (38%) patients achieved spontaneous stone discharge after s hock wave lithotripsy. In 11 (22%) cases, it was possible to remove al l fragments endoscopically; residual fragments remained in 20 (40%) pa tients. Severe complications attributable to shock wave application di d not occur. During follow-up, six patients had to be referred to surg ery; two male patients died of specific diabetic complications and ple ural mesothelioma, respectively. Thirty-five (90%) of 39 patients whos e conditions were followed for 2-50 (20 +/- 14) months reported improv ement of their pain sensations. Six (15%) patients required endoscopic treatment, including ESWL in five of those patients, to be repeated d ue to recurrent formation of calculi in the main pancreatic duct, whic h was again successful in five of the six patients. Conclusions: Piezo electric shock wave lithotripsy offers a basis for safe and effective fragmentation of pancreatic stones and facilitates endoscopic procedur es. Most of the patients with obstructing pancreatic stones became sto nefree and showed a significant reduction of pain.