Although putative pain mechanisms in chronic pancreatitis remain unproved, considerable circumstantial evidence indicts increased glandular and intraductal pressure secondary to fibrotic ductal strictures and/or obstructing intraductal calculi. Surgical decompression of obstructed ducts by pancreatojejunostomy or various forms of pancreatic resection have relieved pain in 60% to 70% of the patients, many of whom were observed for more than 5 years.
Alternative attempts at ductal decompression have been proposed using pancreatic duct stents, transpapillary extraction of calculi (TPE), or fragmentation of intraductal stones with a focused laser or sonic energy (ESWL). Whereas the safety and efficacy of stents is now being questioned, evaluation of the latter approaches continues.
Martin et al describe a modest yet well-studied group of 12 patients with intraductal pancreatic calculi who were treated successfully with TPE alone or TPE combined with ESWL and were followed up for an average of 19 months. More extensive experience with ESWL