Combined modality treatment of symptomatic pancreatic ductal lithiasis
R. F. Martin, B. L. Hanson, J. J. Bosco, J. F. Erkkinen, S. B. Broaddus, W. B. Goldfarb and D. A. Howell
Department of General Surgery, Maine Medical Center, Portland, USA.
OBJECTIVE: To assess the efficacy and safety of the removal of pancreatic
duct stones by a combined modality approach in patients with pancreatic
ductal lithiasis and recurrent abdominal pain. DESIGN: Retrospective review
with a mean follow-up of 19 months (range, 1 to 56 months). SETTING: A
tertiary care, private community hospital with a university affiliation.
PATIENTS: The records of patients who presented to the hospital or who were
referred with recurrent abdominal pain and who were demonstrated to have
pancreatic ductal lithiasis between 1989 and 1994 were reviewed. Patients
were assessed by their clinical response to pancreatic duct stone
extraction by a variety of therapeutic interventions. RESULTS: Fifteen
patients were included in the study. One patient was excluded from analysis
because of a concurrent choledochocele. Two patients required operative
decompression and stone extraction for endoscopically inaccessible stones.
Six patients were treated with endoscopic management alone, and six were
treated with a combination of extracorporeal shock wave lithotripsy and
endoscopic stone retrieval. Twelve patients had complete clearance of the
pancreatic duct. One patient had a stone that was not removed, but adequate
pancreatic ductal decompression was achieved. The remaining patient had
incomplete clearance of pancreatic stone fragments following extracorporeal
shock wave lithotripsy but had adequate ductal drainage. No patient has
required further therapy or hospitalization for abdominal pain. No
complications occurred as a result of any intervention in this study.
CONCLUSIONS: A multidisciplinary combined modality approach is a safe and
effective method for extracting pancreatic duct stones in symptomatic
patients. Stone extraction and reestablishment of adequate ductal drainage
appear to relieve symptoms in some patients.
