Fig. 1Endoscopic intervention for pancreatic duct stones (PDSs). (A) Abdominal computed tomographic scan shows a 4 mm sized calcified stone (white arrow) in pancreatic head within dilated pancreatic duct. (B) Small size of the PDSs let basket removal possible (black arrow). (C) PDS was visualized intraluminally. (D) No filling defect was observed in the main pancreatic duct after complete stone removal.
Fig. 2Endoscopic intervention after extracorporeal shock wave lithotripsy (ESWL) for fragmentation of large stone. (A) Abdominal computed tomographic scan shows 10 mm sized calcified stones (white arrow) in pancreatic head within markedly dilated pancreatic duct. (B) Large pancreatic duct stones in the pancreas head (black arrow) rendered the catheter impassable. (C) After two sessions of ESWL, stones were fragmented to the degree that can be removed with basket. (D) No filling defect was observed in the main pancreatic duct after complete stone removal.
Fig. 3Surgical treatment for multiple large pancreatic duct stones (PDSs). (A) There are extensive calcified stones in pancreatic duct (white arrow). (B) Magnetic resonance cholangiopancreatography shows markedly dilated pancreatic duct with innumerable internal stones. (C) Pancreatogram via major papilla demonstrates pancreatic duct, full of large PDSs (black arrow), which was an indication for surgical treatment. (D) Multiple PDSs removed by Roux-en Y pancreaticojejunostomy surgery.
Table 1Long Term Outcome after Endoscopic Treatment
Table 2Outcomes of Endoscopic Treatment and Surgical Treatment in Randomized Prospective Study