Extracorporeal Shockwave Lithotripsy in Pancreatic Duct Stone Extraction: Updates in Techniques, Outcomes, and Utilization

Extracorporeal shockwave lithotripsy (ESWL) is a non-invasive approach for the management of uncomplicated symptomatic pancreatic calculi in patients with chronic pancreatitis (CP). It can be used to achieve long term pain relief, with or without ERCP. The efficacy of ESWL in treating pancreatic ductal calculi is addressed in detail in this article.

In more than 70% of patients, ESWL treatment leads to total ductal clearance. This relieves pain in more than half of the patients with symptomatic chronic pancreatitis caused by ductal obstruction. In CP patients, ESWL reduces the proportion of patients requiring analgesics and decreases the requirement of surgery. The safety profile of ESWL is favourable, with mild and self-limiting complications that typically do not necessitate intervention. ESWL should be adhered to as a first alternative to conventional endoscopic techniques, as long as there is no convincing data about EHL or laser lithotripsy efficacy.

In view of its high efficiency, non-invasive nature, and low complications rates, ESWL should be offered as the first-line therapy for selected patients with large painful pancreatic calculi.