Patel S. et al., 2020: Combined extracorporeal shockwave lithotripsy and ERCP for chronic calcific pancreatitis with the patient under general anesthesia in one session: an introduction to extracorporeal shockwave lithotripsy and a case example

In this article the authors discuss the treatment of a large radio-opaque pancreatic duct stone. The procedure combined SWL and ERCP during the same session and with the same anaesthesia. It is of note, however, that it was possible to complete the treatment without access to an operating theatre. A solution that makes the treatment very convenient. Successful SWL requires a free path for the shockwave and administration of shockwaves in most cases should be transabdominally. If anaesthetic service can be avoided, treatment with only analgesics and sedatives, this is an attractive approach particularly since these patients often are both old and brittle. The latter treatment modality might be well suited for patients in whom it is likely that the problem can be solved with only SWL. If also ERCP can be carried out with only analgesics and sedatives depends on the patient and the skill of the operator, but such an approach might be possible in many cases. Hans-Göran Tiselius