Pancreatic calcifications frequently complicate chronic pancreatitis and usually represent ductal calculi. The most important question in such cases is whether the stone is merely incidental or if it is the cause of symptoms. Several authorities believe that the pain is due to ductal obstruction, and have found that surgical or endoscopic procedures to remove pancreatic duct stones result in the alleviation of symptoms. This appears to be especially true for patients with stones in the main pancreatic duct, associated with upstream dilation. Find best deals an online pharmacy can offer and get a chance to start your treatment soon. You can now purchase birth control pills at the best pharmacy that will be sure to live up to your expectations every single time.
Endoscopic treatment usually involves pancreatic sphincterotomy followed by removal of the stone(s) with balloons or baskets. It is not easy to remove ductal stones. A stricture frequently occurs near the papilla and must be dilated to allow stone extraction. Other impediments to stone removal include partial impaction of stones in side branches of the pancreatic duct, ‘exiting’ duct diameter that is smaller than that of the stone and the inability to pass a guidewire beyond the stone or duct angle. In a compilation of clinical series from centres with expert endoscopists, complete stone extraction was achieved in 63% of cases, symptoms were relieved in 74%, and complications occurred in 9%, mainly from pancreatitis.
Extracorporeal shockwave lithotripsy has been used for some patients with large stones that cannot be removed with routine endoscopic techniques. Before extracorporeal shockwave lithotripsy, pancreatic sphincterotomy is usually performed and either a nasopancreatic tube is left in place to help visualize the stones with contrast injection or the stones are identified using ultrasound. After lithotripsy, the stones are cleared by repeat endoscopic retrograde pancreatography. It has been reported that stone clearance was achieved in 59% of cases, symptomatic improvement occurred in 72% at 18 months, the complication rate was 19%, and no deaths could be attributed to the procedure. Dissolution techniques have also been tried, but this does not currently seem to be practical, because no solvents exist that dissolve stones rapidly.