EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY OF PANCREATIC DUCT STONES - IMMEDIATE AND LONG-TERM RESULTS

To study the efficacy of extracorporeal shock-wave lithotripsy (ESWL) of pancreatic duct stones, seventeen patients (mean age: 42 years) wit h recurrent attacks of abdominal pain as a result of chronic calcifyin g pancreatitis were treated with this method. In all cases, endoscopic removal of the stones proved impossible. When there was fragmentation , the remaining calculi and fragments either evacuated spontaneously, or attempts were made to extract them endoscopically, followed by flus hing. In 13 patients (76%), fragmentation of stones was achieved, and 11 of these patients had dramatic pain relief directly after ESWL (65% ). However, complete ductal clearance of stones was achieved in only s even patients (41%); at the last follow-up (12-59 months after ESWL, m ean: 30 months), all seven were free of symptoms. Of the six patients with stone fragmentation without ductal clearance, three were operated on because of recurrent complaints. The only complication due to the procedure was an exacerbation of pancreatitis in one patient, which wa s treated conservatively. If pancreatic stones cannot be removed endos copically, ESWL seems to be preferable to surgery, which may still be performed in case of failure. It seems important to achieve ductal cle arance and not merely stone disintegration in order to obtain the desi red long-term clinical effects.