Extracorporeal Shock-Wave Lithoptripsy for Pancreatic Calculi: A 10-year Experience at a Single U.S. Center

Abstract

8.51, 24.89) months respectively (p=0.0267). Conclusion: Additional EPDBD before pancreatic stent insertion may be an effective method for reducing recurrence of pain or attack of acute pancreatitis in patients undergoing endoscopic treatment of PD stricture. *T1525 Extracorporeal Shock-Wave Lithoptripsy for Pancreatic Calculi: A 10-year Experience at a Single U.S. Center Lee McHenry, James L. Watkins, Kenyon Kopecky, Evan L. Fogel, Chi-Liang Cheng, Anne E. Kochell, Lee Ann Shelly, Stuart Sherman, Suzette Schmidt, Thomas J. Howard, Laura Lazzell-Pannell, Glen A. Lehman Background: Extracorporeal shock-wave lithotripsy (ESWL) for pancreatic calculi has been utilized for the non-surgical management of chronic calcific pancreatitis over the past 15 years. The technique and success of ESWL in facilitating partial or complete clearance of pancreatic stones varies between institutions. We report our IndianaUniversity experience of ESWL for pancreatic duct calculi over the past 10 years. Method: A retrospective review of our lithotripsy database from 01/93-11/03 was performed. During this 10 year period, three types of lithotriptors were utilized, including Wolfe ultrasound image piezoelectric lithotriptor (1993-1998) (n=34), Dornier fluoroscopic image sparkgap lithotriptor (1993-2001) (n=42) and Healthtronics Lithotron fluoroscopic image spark-gap lithotriptor (1999-2003) (N=118). The type of lithotriptor, number of sessions, number of sessions per patient, and the complete, partial, or failed clearance of calculi were analyzed. Clearance of main pancreatic duct stones was assessed by the endoscopists at subsequent ERCP. Clearance was defined as complete; (all or >95% of main duct stone burden cleared), partial; (50-95% cleared), and failed; (<50%cleared). Results: A total of 184 patients (106M: 78 F, mean age 51.5 yrs, range 7-87 yrs) underwent a total of 314 ESWL sessions (mean 1.7 sessions per patient; range 1-6 sessions). The number of ESWL sessions per patient varied between lithotriptors: Wolfe 2.6 sessions/patient, Dornier HM-3, 1.5 sessions/patient, and Healthtronics Lithotron 1.3 sessions/patient. Of the 184 patients who underwent ESWL, 174 patients had adequate assessment at followup pancreatography. Complete clearance of main pancreatic duct stones was achieved in 76 patients (44%), partial clearance in 74 patients (42%), and failed clearance in 24 patients (14%). Complete clearance rates were highest with the Dornier (50%) and Healthtronics (42%) spark-gap lithotriptors. Conclusions: ESWL effectively fragments pancreatic stones to allow for complete or partial clearance in 86% of patients. The impact of ESWL in facilitating the complete or partial clearance of pancreatic stones on long-term pain relief in painful chronic calcific pancreatitis requires further investigation.