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Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi—a large single center experience

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Abstract

Aim

Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP.

Methods

Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal.

Conclusion

ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.

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Authors and Affiliations

  1. Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Manu Tandan, Duvvuru Nageshwar Reddy, Mohan Ramchandani, Gupta Rajesh, Sandeep Lakhtakia, Rupa Banerjee & Nitesh Pratap

  2. Department of Anesthesiology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Darisetty Santosh & Kotla Rama

  3. Department of ESWL, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Koppoju Vinod

  4. Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Guduru Venkat Rao

Authors
  1. Manu Tandan
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  2. Duvvuru Nageshwar Reddy
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Correspondence to Manu Tandan.

Additional information

See editorial for this article at http://dx.doi.org/10.1007/s12664-010-0039-7.

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Tandan, M., Reddy, D.N., Santosh, D. et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi—a large single center experience. Indian J Gastroenterol 29, 143–148 (2010). https://doi.org/10.1007/s12664-010-0035-y

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  • DOI: https://doi.org/10.1007/s12664-010-0035-y

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