Safety and Effectiveness of Urologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis

<b><i>Introduction:</i></b> Extracorporeal shock wave lithotripsy (SWL) can be used in conjunction with endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of large (≥5 mm) or impacted pancreatolithiasis. We report our experience demonstrating the safety and effectiveness of urologist-directed SWL for pancreatolithiasis. <b><i>Methods:</i></b> We performed a retrospective review of all patients undergoing SWL for pancreatolithiasis at our institution between 2016 and 2020. We defined a treatment cycle as one in which the patient underwent a predefined number of SWL procedures prior to performance of a post-SWL ERCP. Stone-free status was defined as the absence of stone fragments at post-SWL ERCP. Multivariable logistic regression was performed to determine characteristics associated with stone persistence after a treatment cycle. <b><i>Results:</i></b> There were 44 patients who underwent 59 treatment cycles consisting of 118 pancreatic SWL procedures. Forty-two cycles (71.2%) were staged, and 17 (28.8%) were not staged. The median size of the largest pancreatic stone was 9 mm [IQR 6-11] and was impacted in 38 cases (64.4%). Patients reported pain in 51 cases (86.4%), of which 28 required the use of opioid analgesics. Patients were rendered stone free in 38 cycles (64.4%). Pain improvement was noted in 39 cases (66.1%), and the reduction in opioid use was statistically significant (28 cases vs. 10 cases, <i>P</i> = 0.004). Impacted stones were associated with an increased odds of stone persistence (OR 7.04, 95% CI 1.14-43.43, <i>P</i> = 0.04). <b><i>Conclusions:</i></b> In this joint venture with gastroenterology, we demonstrate that urologist-directed SWL for pancreatolithiasis is safe, effective, and in line with published rates.