Urology, DDC work to avoid invasive surgeryby Heather WoolwinePublic Relations For patients who suffer from pancreatic stones, it’s good news that MUSC’s Department of Urology and the Digestive Disease Center (DDC) get along so well. By pulling expertise from both medical arenas, patients who suffer pancreatic stones now have the option of extracorporeal shock wave lithotripsy (ESWL) as opposed to more invasive surgeries. Commonly used in treating kidney stones for decades, ESWL is used to shock the stone as it rests inside the pancreas and thus break the stone into smaller pieces that are passed through the ducts in the organ. “It’s a bit of a departure from what we usually do (with kidney stones), and we’re still figuring out the most optimum way of doing it,” said Thomas Keane, M.D., Department of Urology chair. “But it is a much better option for many patients as opposed to endoscopic/ laparoscopic procedures or surgery. And because the DDC remains the patients’ primary caregivers, what we’re doing is a real example of interdisciplinary collaboration.” With the first case of ESWL’s use on pancreatic stones surfacing in the late 80s, the concept has been around for awhile, with most of the literature coming from Europe. Patients with pancreatic stones are common in South Carolina; these stones, typically developing as a result of chronic pancreatitis, can easily lead to episodic or even constant debilitating pain. “There has always been a fear of precipitating pancreatitis when using ESWL but most of the patients that would benefit from its use already have a malfunctioning pancreas,” Keane said. “Not everyone who has a pancreatic stone needs it and that’s why the gastrointestinal staff stay in control of the patient from the very beginning.” “When trying to determine whether or not the patient has a pancreatic stone, we look for severe abdominal pain, flares of pancreatitis, and/or other symptoms. The stones can also frequently be seen on X-rays such as a CT scan,” Lawrence said. “Sometimes the stones can be removed completely through the pancreatic duct via a pancreatic sphincterotomy (enlarging the duct’s opening). But sometimes you can’t because there are multiple stones or the stone is simply too big at the time of the Endoscopic Retrograde Cholangio Pancreatography (ERCP).” In addition to imaging processes like ultrasounds, CT scans, and X-rays, an ERCP is conducted with anesthesia and enables gastroenterologists to determine if an ESWL is needed. “Pulverizing a stone makes it much easier on the patient, in terms of medical procedures and passing the stone,” Lawrence said. “Once the procedure is done through Urology, the patient then follows up with the DDC.” Ridding a patient of a pancreatic stone can mean one or multiple visits, and the number of visits depends on numerous variables like a patient’s energy and tolerance levels, the size of the field requiring ESWL, and the size of the stone itself. Sometimes ESWL is performed with sedation and usually requires the patient stay overnight in the hospital. “It has the potential to eliminate the need for major surgery or at least provide one more treatment alternative before going the surgical route,” Lawrence said. “Generally speaking, it can provide complete or partial pain relief and decreases the number of hospitalizations due to pancreatic-related illness. It’s also credited with improving weight gain (appetite increases as pain subsides) and pancreatic function.” Although still in its beginning stages, the Urology and DDC collaboration
to treat pancreatic stones is well under way and produced several success
stories. To learn more about the treatment or to schedule an appointment,
go to http://www.ddc.musc.edu or
call 792-2301.
Friday, Feb. 18, 2005
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