Clin Endosc.  2014 May;47(3):227-235. 10.5946/ce.2014.47.3.227.

Endoscopic Treatment of Pancreatic Calculi

• Kim YH
• Jang SI
• Rhee K
• Lee DK

• KMID: 2049018
• DOI: http://doi.org/10.5946/ce.2014.47.3.227

Abstract

Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal.

Keyword

Pancreatitis, chronic; Calculi; Endoscopy; Surgery; Lithotripsy

MeSH Terms

Abdominal Pain
Calculi*
Consensus
Constriction, Pathologic
Endoscopy
Hospitalization
Humans
Lithotripsy
Pancreas
Pancreatic Ducts
Pancreatitis, Chronic
Shock

Figure

• 

  Fig. 1 Endoscopic intervention for pancreatic duct stones (PDSs). (A) Abdominal computed tomographic scan shows a 4 mm sized calcified stone (white arrow) in pancreatic head within dilated pancreatic duct. (B) Small size of the PDSs let basket removal possible (black arrow). (C) PDS was visualized intraluminally. (D) No filling defect was observed in the main pancreatic duct after complete stone removal.

• 

  Fig. 2 Endoscopic intervention after extracorporeal shock wave lithotripsy (ESWL) for fragmentation of large stone. (A) Abdominal computed tomographic scan shows 10 mm sized calcified stones (white arrow) in pancreatic head within markedly dilated pancreatic duct. (B) Large pancreatic duct stones in the pancreas head (black arrow) rendered the catheter impassable. (C) After two sessions of ESWL, stones were fragmented to the degree that can be removed with basket. (D) No filling defect was observed in the main pancreatic duct after complete stone removal.

• 

  Fig. 3 Surgical treatment for multiple large pancreatic duct stones (PDSs). (A) There are extensive calcified stones in pancreatic duct (white arrow). (B) Magnetic resonance cholangiopancreatography shows markedly dilated pancreatic duct with innumerable internal stones. (C) Pancreatogram via major papilla demonstrates pancreatic duct, full of large PDSs (black arrow), which was an indication for surgical treatment. (D) Multiple PDSs removed by Roux-en Y pancreaticojejunostomy surgery.

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