ENDOSCOPIC TREATMENT AND EXTRACORPOREAL S HOCK-WAVE LITHOTRIPSY IN PATIENTS WITH CHRONIC-PANCREATITIS - RESULTS OF PRELIMINARY EXPERIENCE IN 16 PATIENTS

A new therapeutic approach has been recently proposed in the managemen t of chronic pancreatitis, including pancreatic endoscopic papillotomy and extracorporeal shock wave lithotripsy. The aim of this study was to assess the feasibility and the short - and long-term results of the se procedures in a series of 16 patients aged 48.9 +/- 14 years. The i ndication for endoscopic treatment was pain in 15 cases and steatorrhe a in one case. Pancreatic duct abnormalities included main pancreatic duct stenosis with calculi (9 cases), communicating pseudocysts upstre am to a ductal stenosis or obstruction by calculi (4 cases), and isola ted calculi (4 cases). Clinical response and morphologic parameters we re used for analysis. Mean follow-up was 18.6 months (3.5 months to 7 years). Results : a) pancreatic endoscopic papillotomy, stents placeme nt, and extracorporeal shock wave lithotripsy were sucessfully perform ed in 15 out of 16 cases, 1 out of 4 cases and 8 out of 8 cases, respe ctively; b) symptomatic improvement was observed in 11 of 15 patients with painful pancreatitis as relief was complete in 8, and partial in 3 cases. Pain relapse occurred in these latter 3 patients 4, 18 and 48 months after treatment; diabetes mellitus remained unchanged in all c ases; c) diameter of the main pancreatic duct and pancreatic calcifica tions decreased in 8 of 15 cases and in 10 of 15 cases, respectively; pseudocyst disappeared in 2 of 4 cases; clinical improvement was signi ficantly correlated with pancreatic morphology improvement. Clinical r elapse was associated with calculi recurrence in every case. No compli cation was observed. Endoscopic papillotomy and extracorporeal shock w ave lithotripsy are feasible in most cases of chronic pancreatitis. Re lief of pain is obtained rapidly after treatment and seems to be corre lated with the quality of pancreatic drainage.