Abstract
The indication for the treatment of pancreatic stones is stone location in the main pancreatic duct (MPD) or Santorini duct and the presence of abdominal symptoms. If the diameter of the stone is >5 mm, the initial therapy is extracorporeal shock wave lithotripsy (ESWL), which is safe and minimally invasive. ESWL achieves adequate fragmentation and improves abdominal symptoms. Before ESWL, we usually perform endoscopic pancreatic sphincterotomy (EPST) because it prevents the impaction of crushed stones, acute pancreatitis, and acute cholangitis. However, if the stone is large or multiple stones are present, the success rate of ESWL alone is low, and endoscopic lithotomy is needed. If the size of the stone becomes ˂4 mm after ESWL, endoscopic lithotomy can be performed safely using basket forceps and a balloon catheter. We perform electrohydraulic lithotripsy (EHL) under peroral pancreatoscopy if ESWL fails to fragment the stone. If the stenosis of the MPD is present on the duodenum side of the stone, we perform endoscopic dilation using a dilation catheter and balloon followed by endoscopic pancreatic stenting. Endoscopic treatment is safer if these techniques are used.
This is a preview of subscription content, log in via an institution to check access.
References
Sohma S, Tatekawa I, Okamoto Y, et al. Endoscpic papillotomy: a new approach for extraction of residual stones. Gastroenterol Endosc. 1974;16:446–53. (Japanese with English abstract).
Kawai K, Akasaka Y, Hashimoto Y, et al. Endoscopical sphincterotomy of the ampulla of vater. Gastrointest Endosc. 1974;20:148–51.
Classen M, Demling L. Endoskopische sphinkterotomie der papilla vateri und steinextraktion aus dem ductus choledochus. Dtsch Med Wochenschr. 1974;99:496–7.
Inui K, Nakae Y, Nakamura J, et al. A case of non-calcified pancreatolithiasis which was removed by endoscopic sphincterotomy of the pancreatic duct. Gastroenterol Endosc. 1983;25:1246–53. (Japanese with English abstract).
Sauerbruch T, Holl J, Sackmann M, et al. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis. Endoscopy. 1987;19:207–8.
Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stone with extracorporeal shock wave lithotripsy. Pancreas. 2005;30:26–30.
Thomas M, Howell DA, Carr-Locke D, et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007;102:1896–902.
Draqanov PV, Lin T, Chauhan S, et al. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest Endosc. 2011;73:971–9.
Igarashi Y, Ito K, Mimura T, et al. Endoscopic pancreatic stenting using S-type stent for the benign stricture in the patient with chronic pancreatitis-concept of pioneering and usefulness of endoscopic treatments. Tan to Sui. 2012;33:847–51. (Japanese).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Japan KK, part of Springer Nature
About this chapter
Cite this chapter
Okano, N. et al. (2019). Endoscopic Lithotomy and ESWL for Pancreatic Stones. In: Mine, T., Fujita, R. (eds) Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases. Springer, Tokyo. https://doi.org/10.1007/978-4-431-56009-8_23
Download citation
DOI: https://doi.org/10.1007/978-4-431-56009-8_23
Published:
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-56007-4
Online ISBN: 978-4-431-56009-8
eBook Packages: MedicineMedicine (R0)