# A Case of Pancreatolithiasis Treated by a Combination of Extracorporeal Shock Wave Lithotripsy, Metallic Stent Placement, and Radiofrequency Ablation

## TL;DR

A new treatment combining shock waves, stents, and radiofrequency ablation successfully managed chronic pancreatitis with recurring pancreatic stones.

## Contribution

This is the first reported case using radiofrequency ablation and metallic stent placement for chronic pancreatitis with MPD stricture and recurrent stones.

## Key findings

- The combination therapy successfully cleared stones and prevented recurrence in a patient with MPD stricture.
- Metallic stent placement and radiofrequency ablation provided long-term relief without stone recurrence.
- The treatment approach offers a novel solution for refractory pancreatolithiasis in chronic pancreatitis.

## Abstract

For chronic pancreatitis (CP) with pancreatolithiasis, extracorporeal shock wave lithotripsy (ESWL), endoscopic stenting with plastic stents, and the endoscopic clearance of stone fragments are recommended treatment strategies. However, when a main pancreatic duct (MPD) stricture exists, pancreatolithiasis often becomes recurrent and refractory. However, the combination of radiofrequency ablation and metallic stent placement has recently been performed to treat malignant biliary stricture. In this case, we used a similar treatment in a patient with MPD stricture and recurrent pancreatolithiasis for the first time. A 46-year-old man visited a nearby doctor for abdominal pain. An MPD stone that was approximately 10 mm in length was observed in the pancreatic body on CT, and dilation of the distal MPD was observed. Pancreatolithiasis was found to be recurrent due to an MPD stricture at the pancreatic body following ESWL and endoscopic plastic stent placement. Therefore, we performed endoscopic stone clearance with RFA and endoscopic metallic stent placement. Three months later, the metallic stent was removed. After that, the patient was followed up, and there was no recurrence. The combination of RFA and metallic stent placement can serve as a novel treatment for symptomatic CP with MPD stricture and recurrent and refractory pancreatolithiasis.