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Geusens D. et al., 2021: The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis.

Geusens D, van Malenstein H.
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.

Abstract

Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.
Acta Gastroenterol Belg. 2021 Oct-Dec;84(4):620-626. doi: 10.51821/84.4.027. PMID: 34965044 Review. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Friday, 19 August 2022 10:30

This article is a review of SWL for treatment of patients with chronic pancreatitis caused by stones.
It is important for urologists to have some insight in this problem because the SWL treatment commonly is placed their hands.

The treatment regimen roughly is as follows:
Stone ≤ 5 mm ERCP
Stone > 5 mm SWL

Most pancreatic stones are composed of CaCO3, and such stones are both brittle and radiopaque. If stones are radiolucent, it is necessary to administer contrast medium via a naso-biliary catheter.

One interesting aspect that I personally have not encountered so far, is that secretin can be used to increase pancreatic secretion to get increased fluid around the stone(s).

Apparently, there is no consensus on when ERCP should be carried out in patients for whom combined treatment is planned. Some authors recommend ERCP two days after SWL whereas others prefer ERCP immediately after SWL in the same treatment session.

It might be wise to consider the possible risk of pancreatitis in these patients. Acute pancreatitis occurs in ~ 4% but other complications are rare.

Hans-Göran Tiselius

This article is a review of SWL for treatment of patients with chronic pancreatitis caused by stones. It is important for urologists to have some insight in this problem because the SWL treatment commonly is placed their hands. The treatment regimen roughly is as follows: Stone ≤ 5 mm ERCP Stone > 5 mm SWL Most pancreatic stones are composed of CaCO3, and such stones are both brittle and radiopaque. If stones are radiolucent, it is necessary to administer contrast medium via a naso-biliary catheter. One interesting aspect that I personally have not encountered so far, is that secretin can be used to increase pancreatic secretion to get increased fluid around the stone(s). Apparently, there is no consensus on when ERCP should be carried out in patients for whom combined treatment is planned. Some authors recommend ERCP two days after SWL whereas others prefer ERCP immediately after SWL in the same treatment session. It might be wise to consider the possible risk of pancreatitis in these patients. Acute pancreatitis occurs in ~ 4% but other complications are rare. Hans-Göran Tiselius
Monday, 20 May 2024