Extracorporeal Shock Wave Lithotripsy in Combination with Endoscopic Retrograde Cholangiopancreatography for Treatment of Initial Endotherapy-Failed Pancreatic Ductal Stones: A Retrospective Clinical Study

Zhang J-T, Lu X-S, Gui Y-P and Fan Y-Z

Department of General Surgery, Tongji University School of Medicine, China
Department of Urology, Tongji University School of Medicine, China

^*Correspondance to: Yue-Zu Fan 

 PDF  Full Text DOI: 10.25107/2474-1647.1120

Abstract

Objective: To evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in combination with Endoscopic Retrograde Cholangiopancreatography (ERCP) for treatment of initial Endotherapy failed Pancreatic Ductal Stones (PDSs).
Methods: The clinical data of patients with initial Endotherapy failed PDSs treated by ESWL in combination with ERCP in our hospital were analyzed retrospectively. Radiographic assessments are performed for these patients before treatment. These patients underwent ESWL for stone fragmentation and post-ESWL therapeutic ERCP for endoscopic clearance of stone fragments. Patients’ outcomes including successful stones clearance, pain relief, complications, mortality and stone recurrence were followed-up and observed, respectively.Results: A total of 12 patients with initial Endotherapy failed PDSs received our treatment. Abdominal pain, episodes of pancreatitis, associated diabetes mellitus, concomitant alcohol abuse, malnutrition and idiopathic were observed in 100%, 83.3%, 83.3%, 66.7%, 16.7% and 8.3% of patients, respectively. The causes of the initial Endotherapy failure included: multiple, radiopaque stones with a mean size of >6.33±2.06 mm; concomitant pancreatic duct stricture with upstream main pancreatic duct dilation; and endoscopic pancreatic sphinterotomy inadequacy; in particular, no combination with ESWL. By following-up of a median period of 21 (range 4~60) months, a high rate of effective clearance of PDSs (75.0% complete clearance, 16.7% partial clearance) and a high rate of pain relief (75.0% complete pain relief and 16.7% partial pain relief) were achieved in 91.6% of patients, respectively. No procedure-related major complication and mortality occurred.Conclusion: ESWL in combination with ERCP is an effective and safe treatment procedure for initial Endotherapy failed PDSs.

Keywords

Extracorporeal shock wave lithotripsy (ESWL); Endoscopic therapy; Endoscopic retrograde cholangiopancreatography (ERCP); Pancreatic ductal stone; Treatment

Cite the article

Zhang J-T, Lu X-S, Gui Y-P, Fan Y-Z. Extracorporeal Shock Wave Lithotripsy in Combination with Endoscopic Retrograde Cholangiopancreatography for Treatment of Initial Endotherapy- Failed Pancreatic Ductal Stones: A Retrospective Clinical Study. Clin Surg. 2016; 1: 1120.