37 years old male patient with acute on chronic pancreatitis , CT abdomen revealed mild edema in the head and unicate process with atrohphic body and tail region with peri pancreatic inflammatory exudates , main pancreatic duct is dilated up to 0.5 cm and 0.6 cm main duct stone was noted .
A MRCP with secretin may complete the pancreatic findings.
1) ESWL; 2) pancreatic sphincterotomy and Than cleaning MPD. Pancreatic stent after?
As above; no stent afterwards.
If pain/chronic calcific consider Puestow.
ESWL with PD stenting is the procedure of choice but it takes several sittings including the chances of pancreatitis.In a dilated PD of 0.6 cms with with a single stone of 0.6cms Lap modified peustow or in other cases Head coring can be a one time process. Please see the Link below,Txs
https://youtu.be/p_92o8iq0bk
Assuming that it is not possible to get above the stone with the usual endoscopic tools, the ESWL will effectively shatter the stone and allow subsequent endoscopic removal. If it is possible to get a basket around the stone, a pancreatic sphincterotomy followed removal should be possible. It will be important to characterize if there is a downstream stricture present. If so dilation of the stricture with stenting may be needed before and potentially after stone extraction.
In cases like this the ultimate treatment is a surgical procedure that may allow resolution of pain for many years A Frey or Beger procedure may be performed after resolution of acute process some skilled endoscopist can remove the stone but the pancreatic proces is going to continue
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