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Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis.

Choi EK, Lehman GA - Korean J. Intern. Med. (2012)

Bottom Line: Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis.Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia.In this review, updated management of pancreatic duct stones is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

ABSTRACT
Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

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Related in: MedlinePlus

Extracorporeal shock wave lithotripsy (ESWL) to facilitate removal of pancreatic duct stones. (A) Two pancreatic calcifications (arrows) are seen on the plain film. (B) Two filling defects (arrows) were observed in the main pancreatic duct, which were difficult to remove due to their large size. (C) Radiopaque stones seen alongside the pancreatic stent were fragmented successfully after ESWL. (D) Fragmented pancreatic stones are removed by sweeping using a retrieval balloon.
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Figure 2: Extracorporeal shock wave lithotripsy (ESWL) to facilitate removal of pancreatic duct stones. (A) Two pancreatic calcifications (arrows) are seen on the plain film. (B) Two filling defects (arrows) were observed in the main pancreatic duct, which were difficult to remove due to their large size. (C) Radiopaque stones seen alongside the pancreatic stent were fragmented successfully after ESWL. (D) Fragmented pancreatic stones are removed by sweeping using a retrieval balloon.

Mentions: A significant advancement in pancreatic duct stone removal has been achieved with the application of ESWL for fragmentation. Once fragmented, stone pieces may exit spontaneously or with the aid of ERCP techniques. ESWL has been used to facilitate the removal of pancreatic duct stones during ERCP (Fig. 2). Some studies have reported high stone clearance success rates with ESWL, whereas others have had less impressive results [14,32]. ESWL overcomes the problem of stone size by fragmenting the stones and reducing the stone burden, thus facilitating endoscopic clearance of the duct [24,64,65]. ESWL, which works by concentrating focused shock waves on stones, was first used in the field of gastroenterology by Sauerbruch et al. [66,67] to fragment gall bladder stones and was used later for pancreatic duct stones. Radiopaque stones can be easily targeted by ESWL under fluoroscopy; radiolucent stones can be targeted using ultrasound-guided shock wave lithotripsy or by injection of contrast through a nasopancreatic catheter. ESWL of main pancreatic duct stones is largely considered complementary to endoscopic techniques for stone clearance but has even been proposed as a possible first-line treatment [6,15,68,69].


Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis.

Choi EK, Lehman GA - Korean J. Intern. Med. (2012)

Extracorporeal shock wave lithotripsy (ESWL) to facilitate removal of pancreatic duct stones. (A) Two pancreatic calcifications (arrows) are seen on the plain film. (B) Two filling defects (arrows) were observed in the main pancreatic duct, which were difficult to remove due to their large size. (C) Radiopaque stones seen alongside the pancreatic stent were fragmented successfully after ESWL. (D) Fragmented pancreatic stones are removed by sweeping using a retrieval balloon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3295984&req=5

Figure 2: Extracorporeal shock wave lithotripsy (ESWL) to facilitate removal of pancreatic duct stones. (A) Two pancreatic calcifications (arrows) are seen on the plain film. (B) Two filling defects (arrows) were observed in the main pancreatic duct, which were difficult to remove due to their large size. (C) Radiopaque stones seen alongside the pancreatic stent were fragmented successfully after ESWL. (D) Fragmented pancreatic stones are removed by sweeping using a retrieval balloon.
Mentions: A significant advancement in pancreatic duct stone removal has been achieved with the application of ESWL for fragmentation. Once fragmented, stone pieces may exit spontaneously or with the aid of ERCP techniques. ESWL has been used to facilitate the removal of pancreatic duct stones during ERCP (Fig. 2). Some studies have reported high stone clearance success rates with ESWL, whereas others have had less impressive results [14,32]. ESWL overcomes the problem of stone size by fragmenting the stones and reducing the stone burden, thus facilitating endoscopic clearance of the duct [24,64,65]. ESWL, which works by concentrating focused shock waves on stones, was first used in the field of gastroenterology by Sauerbruch et al. [66,67] to fragment gall bladder stones and was used later for pancreatic duct stones. Radiopaque stones can be easily targeted by ESWL under fluoroscopy; radiolucent stones can be targeted using ultrasound-guided shock wave lithotripsy or by injection of contrast through a nasopancreatic catheter. ESWL of main pancreatic duct stones is largely considered complementary to endoscopic techniques for stone clearance but has even been proposed as a possible first-line treatment [6,15,68,69].

Bottom Line: Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis.Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia.In this review, updated management of pancreatic duct stones is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

ABSTRACT
Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

Show MeSH
Related in: MedlinePlus