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Extracorporeal shock wave lithotripsy and endoscopic pancreatic stenting without pancreatic sphincterotomy for the treatment of pancreatolithiasis: a case series

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Endoscopic therapy and extracorporeal shock wave lithotripsy (ESWL) are recommended as the first choice in treating pancreatolithiasis. Endoscopic therapy is generally performed using endoscopic pancreatic sphincterotomy (EPST). Herein, we report our experience implementing a treatment protocol, combining endoscopic therapy and ESWL without EPST, for pancreatolithiasis. The inpatient treatment plan was performed every 3 months with a set number of sessions of ESWL with endoscopic pancreatic stenting (EPS) implanted or replaced. Finally, treatment was terminated when the stone was removed after implantation of a 10-Fr stent and crushed to approximately 3 mm or after spontaneous stone discharge. Eight patients were included in this study; the median time to stone disappearance was 208.5 days. The median number of inpatient treatment cycles, endoscopic retrograde cholangiopancreatography, and ESWL sessions was 2.5, 3, and 3, respectively. No serious adverse events were observed in all patients. Therefore, combining ESWL and EPS without EPST can safely treat pancreatolithiasis.

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  1. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European society of gastrointestinal endoscopy (ESGE) guideline - updated august 2018. Endoscopy. 2019;51:179–93.

    Article  PubMed  Google Scholar 

  2. Drewes AM, Bouwense SAW, Campbell CM, et al. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology. 2017;17:720–31.

    Article  PubMed  Google Scholar 

  3. Moole H, Jaeger A, Bechtold ML, et al. Success of extracorporeal shock wave lithotripsy in chronic calcific pancreatitis management: a meta-analysis and systematic review. Pancreas. 2016;45:651–8.

    Article  PubMed  Google Scholar 

  4. Suzuki Y, Sugiyama M, Inui K, et al. Management for pancreatolithiasis: a Japanese multicenter study. Pancreas. 2013;42:584–8.

    Article  PubMed  Google Scholar 

  5. Korpela T, Udd M, Tenca A, et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol. 2016;51:866–71.

    Article  PubMed  Google Scholar 

  6. Dumonceau JM, Costamagna G, Tringali A, et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut. 2007;56:545–52.

    Article  PubMed  Google Scholar 

  7. Vaysse T, Boytchev I, Antoni G, et al. Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis. Scand J Gastroenterol. 2016;51:1380–5.

    Article  PubMed  Google Scholar 

  8. Ohara H, Hoshino M, Hayakawa T, et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterol. 1996;91:1388–94.

    CAS  PubMed  Google Scholar 

  9. Kondo H, Naitoh I, Ohara H, et al. Efficacy of pancreatic stenting prior to extracorporeal shock wave lithotripsy for pancreatic stones. Dig Liver Dis. 2014;46:639–44.

    Article  PubMed  Google Scholar 

  10. Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas. 2005;30:26–30.

    PubMed  Google Scholar 

  11. Tadenuma H, Ishihara T, Yamaguchi T, et al. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol. 2005;3:1128–35.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Sherman S, Lehman GA, Hawes RH, et al. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc. 1991;37:511–7.

    Article  CAS  PubMed  Google Scholar 

  14. Tandan M, Reddy DN, Talukdar R, et al. Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis. Gastrointest Endosc. 2013;78:726–33.

    Article  PubMed  Google Scholar 

  15. Choi EK, McHenry L, Watkins JL, et al. Use of intravenous secretin during extracorporeal shock wave lithotripsy to facilitate endoscopic clearance of pancreatic duct stones. Pancreatology. 2012;12:272–5.

    Article  CAS  PubMed  Google Scholar 

  16. Inui K, Igarashi Y, Irisawa A, et al. Japanese clinical guidelines for endoscopic treatment of pancreatolithiasis. Pancreas. 2015;44:1053–64.

    Article  CAS  PubMed  Google Scholar 

  17. Cotton PB, Garrow DA, Gallagher J, et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70:80–8.

    Article  PubMed  Google Scholar 

  18. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–54.

    Article  PubMed  Google Scholar 

  19. Geenen JE, Rolny P. Endoscopic therapy of acute and chronic pancreatitis. Gastrointest Endosc. 1991;37:377–82.

    Article  CAS  PubMed  Google Scholar 

  20. Ikenberry SO, Sherman S, Hawes RH, et al. The occlusion rate of pancreatic stents. Gastrointest Endosc. 1994;40:611–3.

    Article  CAS  PubMed  Google Scholar 

  21. Binmoeller KF, Jue P, Seifert H, et al. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. Endoscopy. 1995;27:638–44.

    Article  CAS  PubMed  Google Scholar 

  22. Kawaguchi Y, Lin JC, Kawashima Y, et al. Risk factors for migration, fracture, and dislocation of pancreatic stents. Gastroenterol Res Pract. 2015;2015: 365457.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yasuda I, Tomita E, Enya M, et al. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut. 2001;49:686–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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There was no specific financial support. The case series was managed in a routine clinical context.

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Authors and Affiliations



SE and SK contributed to the study conception and design. SE, SK, and TS examined and cared for the patient. Material preparation, data collection, and analysis were performed by SE. The first draft of the manuscript was written by SE and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shinya Endo.

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All procedures followed were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its subsequent amendments.

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Informed consent was obtained from all patients in this study.

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Endo, S., Kawaguchi, S., Satoh, T. et al. Extracorporeal shock wave lithotripsy and endoscopic pancreatic stenting without pancreatic sphincterotomy for the treatment of pancreatolithiasis: a case series. Clin J Gastroenterol 16, 615–622 (2023).

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