Combined extracorporeal shockwave lithotripsy and ERCP for chronic calcific pancreatitis with the patient under general anesthesia in one session: an introduction to extracorporeal shockwave lithotripsy and a case example

摘要

The role of extracorporeal shockwave lithotripsy (ESWL) in the management of patients with chronic calcific pancreatitis is evolving. The European Society of Gastroin- testinal Endoscopy recommends ESWL for the clearance of radiopaque obstructive main pancreatic duct (PD) stones larger than 5 mm located in the head or body of the pancreas because standard ERCP methods are less likely to result in successful stone clearance. 1 However, although it is known to improve pain and quality of life in chronic calcific pancreatitis according to case studies and meta-analyses, 2 ESWL is not currently widely available in the United States because of a lack of randomized controlled trials or lack of equipment, as well as difficulty in setting up such a procedure. Herein, we report the successful clearance of a very large PD calculus by safely performing a single-anesthesia, com- bined ESWL-ERCP procedure within the endoscopy suite, thus bypassing the need for an operating room and sepa- rate anesthesia sessions (Video 1, available online at www.VideoGIE.org).