Gnecco J. et al., 2023: Pancreatic Stones and Extracorporeal Shockwave Lithotripsy: A Review of the Literature
Gnecco J, Brown LK, Boregowda U, Abidali H, Saligram S, Rosenkranz L, Patel S, Haluskza O, Sayana H.
From the Department of Internal Medicine.
Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX.
Department of Hospital Medicine, Bassett Medical Center, Cooperstown, NY.
Department of Gastroenterology, University of Arizona, Tucson, AZ.
Pancreatic stones are sequelae of chronic pancreatitis, resulting in poor quality of life, frequent hospitalizations, and a significant economic burden. Extracorporeal shock wave lithotripsy (ESWL) can be used to treat pancreatic stones and is less invasive when compared to other modalities. In this review article, we have discussed the role of ESWL in the treatment of pancreatic stones and how it differs from other modalities. Databases were searched electronically for articles discussing the treatment of pancreatic ductal stones by ESWL or other modalities. Articles discussing or comparing treatment success rates were preferentially included. An inductive approach was used to identify articles related to the treatment of pancreatic stones with ESWL throughout the review process. Although laser lithotripsy and electrohydraulic lithotripsy appear to have higher success rates, the potential for ESWL to affect clinical outcomes is substantial, especially in individuals with a higher risk for invasive procedures. The decision to perform ESWL should be considered if the outcome will substantially alter the clinical management when performed by an experienced endoscopist. Further randomized controlled trials are needed to compare ESWL and peroral pancreatic lithotripsy methods.
Pancreas. 2022 Sep 1;51(8):916-922. doi: 10.1097/MPA.0000000000002129. PMID: 36607935 Review.
Pancreatic stones are not a urological disease, but SWL of such stones often becomes a task for the urologist responsible for SWL in the hospital. Some background information therefore might be of value also for urologists or other operators of the SWL equipment.
Pancreatic stones are caused by chronic pancreatitis, and they usually are in the pancreatic ducts. The chemical composition of pancreatic stones is calcium carbonate and in my experience such stones are brittle and easy to disintegrate. The authors also discuss treatment of bile duct stones composed of cholesterol, but SWL of such stones is an entirely different problem. Such stones are radiolucent and require radiological visualization with contrast medium.
Disintegration of pancreatic stones is usually successful with stone clearance of > 70 % and partial clearance in > 20 %.
To combine SWL and ERCP is one way to further increase stone clearance, but SWL alone is a method perfectly well suited for patients with advanced morbidity for whom invasive procedures might be too demanding.
The endpoint of the article is – as in almost every report on SWL – that additional studies are necessary for appropriate comparison with endoscopic procedures. My personal view on that is that the radio-opaque calcium carbonate stones are so easy to locate and treat that SWL is an excellent first line treatment. Only if disintegration is less successful despite repeated SWL-sessions, might it be necessary to consider endoscopic procedures.