Balloon-endoscopic retrograde pancreatography employed for extracorporeal shockwave pancreatic lithotripsy

Painful pancreatolithiasis may be alleviated by removing pancreatic stones that occlude the pancreatic duct. In five patients with pancreatolithiasis, preoperative endoscopic retrograde pancreatography showed filling defects in the dilated main pancreatic duct. Endoscopic sphincterotomy and subsequent attempts at stone extraction with a basket and/or a balloon catheter failed to achieve complete clearance of stones. Extracorporeal shockwave lithotripsy (ESWL) was performed under fluoroscopic pancreatographic control, using an indwelling balloon catheter; complete removal of the stones was achieved. Balloon pancreatography facilitated visualization of radiolucent stones during ESWL. Insertion of the balloon catheter is easier than using a nasopancreatic tube, even when there are calculi near the duodenal papilla. This is method extends the repertoire of choices for focusing shockwaves on radiolucent pancreatic stones during ESWL.