Background Endoscopic clearance of large pancreatic duct calculi has always been a challenge to endoscopists. Fragmentation of stones using extracorporeal shockwave lithotripsy is an excellent modality for such patients. This prospective study was carried out to investigate the efficacy and safety of Extracorporeal Shockwave Lithotripsy in clearance of large pancreatic duct calculi in previously failed endoscopic retrograde cholangio-pancreatography. Methods The study populations consisted of 105 patients of Chronic Calcific Pancreatitis who had abdominal pain with large pancreatic duct calculi documented on magnetic resonance cholangio-pancreatograpghy. All patients were subjected to extracorporeal shockwave lithotripsy sessions till stones got fragmented followed by endoscopic retrograde cholangio-pancreatography for pancreatic duct clearance. Results 105 patients underwent endoscopic retrograde cholangio-pancreatography for pancreatic duct calculi during the study period. There were 35 males and 70 females. The age of the patients ranged from 21-62 years with mean age of 43.7 ± 9.6 years. Main pancreatic duct was completely cleared in 82 patients and partially cleared in 15 patients. In 8 patients, there was failure of clearance. There was no statistically significant correlation with age, gender, stone size, stone number, extracorporeal shockwave lithotripsy sessions, number of shocks and main pancreatic duct diameter. Conclusion Extracorporeal shockwave lithotripsy is an effective and safe treatment modality for clearance of large pancreatic duct calculi with an excellent ductal clearance rate and pain relief.
Zafar A Wani, Shabir A Shiekh, Shafat S Lone, Mushtaq A Khan, Showkat A. Zargar