Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

Figure 1 Principle of extracorporeal shockwave lithotripsy. Shockwaves from the source are targeted on the calculi and these induce fragmentation.

Figure 2 Protocol followed at Asian Institute of Gastroenterology, for extracorporeal shockwave lithotripsy of large pancreatic duct calculi[7]. EPS: Endoscopic pancreatic sphincterotomy; US: Ultrasound; EUS: Endoscopic ultrasound; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; PD: Pancreatic duct; ESWL: Extracorporeal shock wave lithotripsy; NPT: Naso-pancreatic tube.

Figure 3 Third-generation lithotripter with fluoroscopic and ultrasound imaging facility.

Figure 4 Large pancreatic calculi in head and genu, cleared by extracorporeal shockwave lithotripsy followed by pancreatic stenting. ESWL: Extracorporeal shockwave lithotripsy.

Figure 5 Large pancreatic calculi in head. Post extracorporeal shockwave lithotripsy (ESWL) reduction in diameter of main pancreatic duct.

Figure 6 Protocol for extracorporeal shockwave lithotripsy of large common bile duct calculi. CBD: Common bile duct; ERCP: Endoscopic retrograde cholangiopancreatography; NBT: Nasobiliary tube; ESWL: Extracorporeal shockwave lithotripsy.

Figure 7 Large common bile duct calculi with narrow distal common bile duct. Good fragmentation achieved with extracorporeal shockwave lithotripsy (ESWL).