Non-surgical treatments for chronic pancreatitis.

Non-surgical, less invasive treatment has been required for chronic pancreatitis. We attempted endoscopic approach and extracorporeal shock wave lithotripsy (ESWL) for the treatment of 54 patients with chronic pancreatitis. Endoscopic procedures, such as endoscopic pancreatic sphincterotomy, cystenterostomy and endoprosthesis, were performed in selected 11 patients with pancreatic stones, protein plugs, pseudocysts and main pancreatic duct stenosis. Successful results were obtained in all 11 patients. ESWL was used for the treatment of 43 patients with pancreatic stones. Combined with ESWL, endoscopic treatments were also used in 7 patients. Stone disintegration was achieved in 36/43 patients (83.8%), and complete clearance of main pancreatic duct was obtained in 19 (44.1%). Pain relief was observed in 27/29 (93%). Improvement of exocrine pancreatic function, evaluated by PFD test, was recognized in 10/19 (52.6%). ESWL is a safe and effective treatment for pancreatolithiasis. Endoscopic approach is, when it will be carefully performed, a less invasive and useful treatment for main pancreatic duct stenosis or pancreatic pseudocyst.