ESWL—The Shocks are Beneficial

Introduction

Extracorporeal shock wave lithotripsy (ESWL) was first utilized for fragmenting renal stones. Its therapeutic benefit was soon extended to biliary and pancreatic calculi. For over two decades, it has been used to fragment and clear large pancreatic duct (PD) calculi. To a lesser extent, it has also been used for fragmenting large bile duct and intrahepatic calculi not amenable to extraction by other available techniques.[1] [2] [3] [4] [5] [6] [7]

In this journal, Khan et al.[8] have published data on efficacy and safety of ESWL for large common bile duct (CBD) and PD calculi. Of the 40 patients with large CBD stones, 37 patients had complete clearance and the others were subjected to surgery. All the 21 patients with chronic calcific pancreatitis (CCP) had complete clearance. Complications were minimal and mild in both these types of calculi. The authors found no significant factors that influence fragmentation. Follow-up for a short period showed good pain relief. This has been the experience of all centers that use ESWL for pancreatic and biliary calculi. Though the numbers in this study are not large, such work is to be encouraged as CCP is widely prevalent in our country.

• References

• 1 Tandan M, Talukdar R, Reddy DN. Management of pancreatic calculi: an update. Gut Liver 2016; 10 (06) 873-880
• 2 Tandan M, Reddy DN, Santosh D. et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi—a large single center experience. Indian J Gastroenterol 2010; 29 (04) 143-148
• 3 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012; 44 (08) 784-800
• 4 Guda NM, Partington S, Freeman ML. Extracorporeal shock wave lithotripsy in the management of chronic calcific pancreatitis: a meta-analysis. JOP 2005; 6 (01) 6-12
• 5 Binmoeller KF, Schafer TW. Endoscopic management of bile duct stones. J Clin Gastroenterol 2001; 32 (02) 106-118
• 6 Hochberger J, Tex S, Maiss J, Hahn EG. Management of difficult common bile duct stones. Gastrointest Endosc Clin N Am 2003; 13 (04) 623-634
• 7 Tandan M, Reddy DN, Talukdar R. et al. Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis. Gastrointest Endosc 2013; 78 (05) 726-733
• 8 Khan MA, Dar HA, Wani ZA. et al. Extracorporeal Shock Wave Lithotripsy for Large Common Bile Duct and Pancreatic Duct Stones: Efficacy, Safety and Analysis of Factors That Favor Stone Fragmentation. J Digest Endosc 2019; 10 (02) 118-123
• 9 Tandan M, Reddy DN. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones. World J Gastroenterol 2011; 17 (39) 4365-4371