Endoscopic balloon sphincteroplasty for extraction of large radiolucent pancreatic duct stones (with videos)

Background

Although radiopaque pancreatic duct stones can be targeted by extracorporeal shock wave lithotripsy (ESWL) and extracted by ERCP, large and radiolucent stones remain a therapeutic challenge.

Objective

To evaluate the technical success and safety of endoscopic balloon sphincter dilation technique (sphincteroplasty) for extraction of large radiolucent pancreatic duct stones.

Design

Case series.

Setting

Tertiary referral center.

Patients

Four symptomatic patients with large (≥1 cm) radiolucent stones occluding the main pancreatic duct that could not be retrieved by standard endoscopic maneuvers.

Interventions

Pancreatic sphincterotomy followed by balloon dilation of the pancreatic orifice to aid retrieval of large radiolucent stones occluding the main pancreatic duct.

Main Outcome Measurements

Technical success and safety of the balloon dilation (sphincteroplasty) technique. Technical success was defined as the ability to achieve pancreatic duct clearance in 1 endoscopic encounter. Complications were assessed according to consensus criteria.

Results

The procedure was technically successful in all 4 patients. Pancreatic duct clearance was achieved in all 4 patients in 1 endoscopy session with complete symptom relief at 12-month follow-up. Mild post-ERCP pancreatitis developed in 1 patient, and minor bleeding developed in another patient; both were managed conservatively.

Limitation

Small number of patients.

Conclusions

Endoscopic balloon dilation of the pancreatic orifice after sphincterotomy is a safe technique that facilitates the removal of large radiolucent stones from the main pancreatic duct in 1 endoscopic session. More studies with larger numbers of patients are required before this technique can be adopted routinely as a treatment alternative for patients with large radiolucent pancreatic duct stones.

Abbreviations: CP, chronic pancreatitis, ESWL, extracorporeal shock wave lithotripsy