Role of extracorporeal shock wave lithotripsy in the treatment of pancreatic stones

Calcifications in chronic pancreatitis are usually the result of chronic inflammation or altered metabolism. Calcifications can perpetuate the cycle of ductal obstruction and contribute to pain, worsening of pancreatic inflammation, ductal disruption, and deterioration of the exocrine and endocrine function of the gland. Removal of pancreatic duct calculi can reduce pain and improve glandular function. Purely endoscopic stone removal has limited success, because of stone location, burden, and presence of strictures in the pancreatic duct. Extracorporeal shock wave lithotripsy (ESWL) allows fragmentation of stones refractory to endoscopic methods and facilitates spontaneous stone passage or endoscopic removal. Among the various forms of lithotripters, none is clearly superior to the others. Current data suggest that ESWL is effective in complete duct clearance in up to 50% of patients and in duct decompression and symptomatic improvement in up to 70% of patients. ESWL should be considered as a useful adjunctive tool in the treatment of pancreatic duct calculi.