Endoscopic treatment of pancreatic duct stones using a 10F pancreatoscope and electrohydraulic lithotripsy

Background: Endoscopic therapy with adjunctive extracorporeal shock wave li thotripsy fails to provide clearance of pancreatic duct stones in up to 25% of symptomatic patients. Direct. contact lithotripsy may provide an additi onal option for removal of refractory stones. We report our initial experie nce using a prototype 10F "baby" endoscope to administer electrohydraulic l ithotripsy. Methods: Five patients failing extracorporeal shock wave lithotripsy and on e patient with recurrent pancreatic duct stones after surgery were selected to undergo endoscopic electrohydraulic lithotripsy. After pancreatic sphin cterotomy and balloon dilation (8 or 10 mm), the 10F endoscope was introduc ed and electrohydraulic lithotripsy was used to fragment stones under direc t visualization. Results: Six patients underwent 9 intraductal electrohydraulic lithotripsy procedures. Complete or partial pancreatic duct clearance was accomplished in all but one. No complications from the lithotripsy procedure were noted. The 5 patients with partial or complete duct clearance experienced complet e relief of abdominal pain of at least 6 months' duration following their f inal procedure. Conclusion: Electrohydraulic lithotripsy within the pancreatic duct provide s an adjunctive endoscopic option for treatment of patients with symptomati c pancreatic duct stones. Our initial experience suggests that electrohydra ulic lithotripsy therapy can successfully fragment stones refractory to con ventional endoscopic stone extraction methods or extracorporeal shock wave lithotripsy. Further experience is necessary to establish the risks of elec trohydraulic lithotripsy within the pancreatic duct.