Endoscopic treatment of an impacted pancreatic duct stone using a balloon catheter for electrohydraulic lithotripsy without pancreatoscopy.

Obstructing main pancreatic duct (PD) stones represent a challenge for endoscopic removal because they are frequently impacted within the duct, are hard, and process sharp edges. Multiple series have been published demonstrating that removal of obstructing stones in the main PD can improve symptoms in the majority of patients with chronic pancreatitis. Extracorporeal shock wave lithotripsy (ESWL) has become an accepted technique to facilitate stone clearance when standard endoscopic methods fail. More recently, direct contact lithotripsy with the use of smaller caliber endoscopes has been described as an alternative to ESWL. Limited experience suggests that intraductal electrohydraulic lithotripsy under direct endoscopic visualization with a small caliber pancreatoscope results in successful fragmentation of PD stones that have been refractory to standard endoscopic methods or ESWL. Herein, we report the use of intraductal electrohydraulic lithotripsy to fragment a large obstructing PD stone guided only by fluoroscopy without the utilization of a pancreatoscope.