Hashimoto R. Pancreatoscopy guided lithotripsy for difficult pancreatic duct stones: Evidence and treatment selection in chronic pancreatitis. World J Gastrointest Endosc 2026; 18(8): 122451 [DOI: 10.4253/wjge.122451]
Corresponding Author of This Article
Rintaro Hashimoto, MD, PhD, Assistant Professor, Department of Internal Medicine, University of Iowa Health Care, 200 Hawkins Dr, Iowa City, IA 52242, United States. rintaro-hashimoto@uiowa.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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World J Gastrointest Endosc. Aug 16, 2026; 18(8): 122451 Published online Aug 16, 2026. doi: 10.4253/wjge.122451
Pancreatoscopy guided lithotripsy for difficult pancreatic duct stones: Evidence and treatment selection in chronic pancreatitis
Rintaro Hashimoto
Rintaro Hashimoto, Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA 52242, United States
Author contributions: Hashimoto R conceived and designed the review, performed the literature search, selected and interpreted the relevant studies, drafted the manuscript, prepared the tables and figures, critically revised the manuscript for important intellectual content, approved the final version of the manuscript, and agrees to be accountable for all aspects of the work.
AI contribution statement: During the preparation of this manuscript, the author used ChatGPT (OpenAI) solely for English language editing and to improve clarity and readability.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Rintaro Hashimoto, MD, PhD, Assistant Professor, Department of Internal Medicine, University of Iowa Health Care, 200 Hawkins Dr, Iowa City, IA 52242, United States. rintaro-hashimoto@uiowa.edu
Received: April 20, 2026 Revised: June 6, 2026 Accepted: July 20, 2026 Published online: August 16, 2026 Processing time: 113 Days and 1.4 Hours
Core Tip
Core Tip: Pancreatoscopy-guided lithotripsy has become a useful option for difficult pancreatic duct stones, but the available evidence does not justify replacing extracorporeal shock wave lithotripsy as the default strategy. Its role should be decided case by case. Stone size, computed tomography attenuation, radiopacity, overall stone burden, duct anatomy, downstream strictures, access route, local expertise, and the expected number of procedures all matter. Success should also be measured beyond duct clearance. Pain relief, quality of life, opioid use, hospitalizations, need for repeat intervention, nutritional status, pancreatic function, and timely referral for surgery should all be part of treatment selection. In this setting, duct clearance is only one outcome; the more important question is whether treatment changes the patient’s clinical course.
