ESWL Versus ESWL and Endoscopic Treatment
ESWL Versus ESWL and Endoscopic Treatment
The study wants to compare ESWL alone with ESWL and endoscopic drainage of the MPD for
 treatment of pain in chronic pancreatitis.
The combination mode of ESWL and ERCP is an established method of treatment of painful
 obstructive calcified chronic pancreatitis. However, the investigators notice that patients
 after ESWL alone in calcified CP is followed by spontaneous elimination of stone fragments
 and pain relief. Inui reported that 40% of 555 patients spontaneous eliminate stone
 fragments. Dumonceau found that combining systematic endoscopy with ESWL adds to the cost of
 patient care, without improving the outcome of the pancreatic pain.

 So the investigators design such a prospective and randomized controlled trial. People
 diagnosed with uncomplicated painful chronic pancreatitis and calcifications obstructing the
 MPD will be randomly assigned to the ESWL or endoscopy group according to a table of random
 numbers.

 ESWL will be performed in all patients using a electromagnetic lithotriptor. ESWL sessions
 will be repeated if necessary, until stone fragmentation is obtained. Patients in the
 endoscopy group will undergo endoscopy in 48 hours with possible stent insertion. In the ESWL
 group, if pain continues or aggravates, endoscopic drainage of the MPD will be carried out.

 Follow-up will consists of telephone interview1 after treatment and clinical examination
 every 6 months thereafter. Data collected will include clinical presentation, ESWL,
 endoscopic and surgical procedures, life quality. In addition, S-MRCP will be performed 6
 months after treatment. Blood glucose, insulin, stool elastase will be taken each clinical
 examination.
Inclusion Criteria:

 -  painful chronic pancreatitis(abdominal pain attack during the preceding 12 months);

 -  at least 1 calcified stone greater than 5 mm in one of its axes in the cephalic or
 corporeal portion of the main pancreatic duct with upstream duct dilation;

 -  no ERCP or ESWL carried out before admission

 Exclusion Criteria:

 -  suspected to have malignant tumors;

 -  history of pancreatic surgery or gastrojejunostomy (Billroth II);

 -  pancreatic collection greater than 2 cm in diameter at magnetic resonance or CT scan;

 -  age below 18 years;

 -  pregnancy or lactation;

 -  refuse to write informed consent