Tandan M et al, 2016: Management of Pancreatic Calculi: An Update.
Tandan M, Talukdar R, Reddy DN.
Asian Institute of Gastroenterology, Hyderabad, India.
Asian Healthcare Foundation, Hyderabad, India.
Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.
Gut Liver. 2016 Nov 15;10(6):873-880. doi: 10.5009/gnl15555. FREE ARTICLE
This paper focusses on the authors experience with 2800 cases of ESWL for pancreatic calculi (PC) which “is now the accepted standard of care for the management of large PC at major centers all over the world.”
I refer to my recent review on Vaysse T, Boytchev I, Antoni G, Croix DS, Choury AD, Laurent V, Pelletier G, Buffet C, Bou-Farah R, Carbonnel F. Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis. Scand J Gastroenterol. 2016 Aug 9:1-6.