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2016 ; 10
(6
): 873-880
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English Wikipedia
Management of Pancreatic Calculi: An Update
#MMPMID27784844
Tandan M
; Talukdar R
; Reddy DN
Gut Liver
2016[Nov]; 10
(6
): 873-880
PMID27784844
show ga
Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic
pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma.
Calculi are the end result, irrespective of the etiology of CP. PC contains an
inner nidus surrounded by successive layers of calcium carbonate. These calculi
obstruct the pancreatic ducts and produce ductal hypertension, which leads to
pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to
clear these calculi and decrease ductal hypertension. In small PC, endoscopic
retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and
extraction is the treatment of choice. Large calculi require fragmentation by
extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or
spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the
standard of care for the management of large PC. Long-term outcomes following
ESWL have demonstrated good pain relief in approximately 60% of patients.
However, ESWL has limitations. Per oral pancreatoscopy and intraductal
lithotripsy represent techniques in evolution, and in current practice their use
is limited to centers with considerable expertise. Surgery should be offered to
all patients with extensive PC, associated multiple ductal strictures or
following failed endotherapy.
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