A Minimally Invasive Alternative for Managing Large Pancreatic Duct Stones Using a Modified Expandable Metal Mesh Stent

Background and Aim: Endoscopic clearance of large or impacted stones in the main pancreatic duct (MPD) remains a clinical challenge. In this study, we attempted to technically modify the metallic stent to facilitate the clearance of large pancreatic stones in 4 patients, hoping to lower the operative risks and shorten hospital stay. Patients and Methods: Four patients with chronic pancreatitis and large stones in the MPD received endoscopic treatment. Inclusion criteria were:(1) pancreatic intraductal stones (number>3; diameter >10 mm) and strictures identified in the distal MPD; (2) calculi mainly located in the head, neckand/or body of the pancreas, and (3) failed clearance of stones using a balloon catheter or Dormia basket. Before clearing the pancreatic calculi completely, a technically modified uncovered self-expandable metallic pancreatic stent was implanted in the MPD for 4-7 days to dilate the ductal stenosis, and then drawn out through the working channel. Results: As theMPD had been sufficiently expanded by the stent, the calculi were removed completely and uneventfully by the balloon or Dormia basket in all 4 patients, without inducing major postoperative complications. A 9- to 15-month follow-up did not find major complications or recurrence of large calculi in the MPD. Conclusions: Technically modified metallic stenting is a minimally invasive and clinically feasible alternative to extra-corporeal shock wave lithotripsy in the management of large pancreatic duct Stones.