PTU-003 Extracorporeal shock wave lithotripsy with a transportable mini-lithotripter and subsequent endoscopic duct clearance for treatment of obstructive pancreatic duct stones

IntroductionExtracorporeal shock wave lithotripsy (ESWL) of pancreatic duct stones, followed by endoscopic retrograde cholangio-pancreaticography (ERCP) with mechanical clearance of the pancreatic duct, and subsequent stenting is an established treatment option in patients with chronic calcifying pancreatitis.AimTo test the efficacy of a modified transportable minilithotriptor for ESWL of pancreatic duct stones.MethodsWe prospectively studied 32 patients with obstructive chronic calcifying pancreatitis with pain as a dominant symptom who underwent extracorporeal shock wave lithotripsy (ESWL) using the modified transportable minilithotriptor. ESWL was followed by ERCP for stone clearance of the pancreatic duct and mechanical removal of stones or stenting. Pre- and postprocedure pain and quality of life was assessed using a 5-point analog score and a 5-step verbal life satisfication.ResultsIn all patients the endoscopic treatmet was successful as we could clear the pancretic duct completely from fragmented stones (40.6%) or were able to insert a pancreatic stent for decompression (59.4%) of the duct. A median of 4 ESWL sessions (range 1–15) with a median of 6800 shockwaves (1000–34.700) were required. Pain relief after ESWL only was noted in 24 patients (75.0%), while no change in the intensity of pain was reported by seven patients (21.9%), pain was worse in one patient. All patients underwent ERCP and stent placement, resulting in complete resolution of pain in 17 patients (84.4%), pain improvement in 27 patients (84.4%). When asked to score their quality of life before and after the two procedures were undertaken, all patients found that their overall quality of life significantly improved after ESWL and endoscopic stenting.ConclusionExtracorporal shock wave lithotripsy with the mini-lithotriptor results in fragmentation of pancreatic duct calculi. ESWL in conjunction with endoscopic clearance of the main pancreatic duct and stenting is associated with significant improvement in clinical outcome and quality of life in patients with obstructive calcifying chronic pancreatitis.