Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy

Background-There have been conflicting reports as to whether pancreatic duc tal drainage achieved by endoscopy and lithotripsy improves the clinical ou tcome of patients with chronic pancreatitis. Aims-To determine the clinical outcome in patients with chronic pancreatiti s who received extracorporeal shock wave lithotripsy (ESWL), and were follo wed up for two to eight years. Methods-Eighty patients with severe chronic pancreatitis and endoscopically unretrievable obstructive stones underwent ESWL with a piezoelectric Litho tripter between 1989 and 1996. Clinical status, relief of symptoms, further endoscopic or surgical interventions, and mortality were defined. Results-Forty three (54%) patients were treated successfully with ESWL. The only feature associated with treatment success was the presence of a singl e stone rather than multiple stones. Successfully treated patients tended t o experience less pain, although this did not reach statistical significanc e. A slight increase in weight was noted in our patients; however, there wa s no notable improvement in anomalous stools and diabetes mellitus. Five pa tients died due to extrapancreatic reasons. No pancreatic carcinomas develo ped. Conclusions-ESWL associated with endoscopic drainage is a safe technique th at is particularly successful in patients with a single stone. However, pan creatic drainage by endoscopy and ESWL has almost no effect on pain in chro nic pancreatitis. Furthermore, endoscopic management and ESWL does not prev ent or postpone the development of glandular insufficiency.