Extracorporeal Shock Wave Lithotripsy (ESWL) without Endoscopic Lithotomy for Pancreatolithiasis : A Report of Two Cases

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Extracorporeal shock wave lithotripsy (ESWL) without endoscopic sphincterotomy (EST) for pancreatic duct stones was performed in two patients with chronic pancreatitis. Case 1 was a 37-year-old man. Pancreatic stones were observed in the pancreatic head and tail region with a persistent pancreatic fistula. ESWL without EST for pancreatolithiasis was performed two times. Almost all the stones in the pancreatic head were disintegrated without any complications by ESWL (4700 shock waves at 24.0 KV) under fluoroscopic control using a lithotriptor (Dornier MLF 5000). Consequently, the fistula closed and the pancreatic exocrine function recovered. Case 2 was a 65-year-old woman suffering from chronic relapsing pancreatitis with calcified stones in the pancreatic head region. ESWL (5700 shock waves at 23.0 KV) without EST produced complete disintegration of the stones without any complications. Seven days later, almost all of the stones in the pancreatic head were diminished. Thereafter, we observed not only amelioration of the symptoms of pancreatitis but also improvement in pancreatic exocrine function. Thus, ESWL treatment without EST was a safe and effective method for pancreatolithiasis and should be considered a high-priority non-surgical treatment for pancreatolithiasis.