Sharzehi K., 2019: Management of Pancreatic Duct Stones
Division of Gastroenterology & Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
PURPOSE OF REVIEW: Pancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis. Stone resolution has shown to improve pain. The goal of this review is to highlight recent endoscopic and surgical advancements in treatment of pancreatic duct stonesRECENT FINDINGS: Stone fragmentation by extracorporeal shock wave lithotripsy has become first line and the mainstay of treatment for majority of patients with pancreatic duct stones. Introduction of digital video pancreatoscopy in the last few years with the capability of guided lithotripsy has provided a robust therapeutic option where extracorporeal shock wave lithotripsy is unsuccessful or unavailable. Historically, surgery has been considered a more reliable and durable option when feasible. However, it had not been compared with more effective endoscopic therapy. Lithotripsy (extracorporeal and pancreatoscopy guided) is evolving as a strong treatment modality for pancreatic stones.
Curr Gastroenterol Rep. 2019 Dec 4;21(11):63. doi: 10.1007/s11894-019-0727-0.
SWL treatment of pancreatic stones is considered a first line treatment and inasmuch as urologists in most places are responsible for this form of treatment it is important to be aware of what gastroenterologists expect from non-invasive stone disintegration.
This review gives some important hints on what can be achieved with SWL for this group of patients given that stones in chronic pancreatitis is the main reason for pain.
1. Indication: usually stones > 5mm
2. Stones in head and body
3. For radiolucent stones a stent might be necessary
4. The results are best with solitary stones
5. Density should ideally be