Wan ML, Chen YJ, Wang B. Pancreatic duct stone management strategies: Advances and clinical practice in chronic pancreatitis. World J Gastrointest Surg 2026; 18(9): 122002 [DOI: 10.4240/wjgs.122002]
Corresponding Author of This Article
Bing Wang, PhD, Associate Chief Physician, Department of Hepatic-Biliary-Pancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 430030, Hubei Province, China. 2013tj0575@hust.edu.cn
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Gastroenterology & Hepatology
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review-article
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Wan ML, Chen YJ, Wang B. Pancreatic duct stone management strategies: Advances and clinical practice in chronic pancreatitis. World J Gastrointest Surg 2026; 18(9): 122002 [DOI: 10.4240/wjgs.122002]
World J Gastrointest Surg. Sep 27, 2026; 18(9): 122002 Published online Sep 27, 2026. doi: 10.4240/wjgs.122002
Pancreatic duct stone management strategies: Advances and clinical practice in chronic pancreatitis
Mao-Lin Wan, Yong-Jun Chen, Bing Wang
Mao-Lin Wan, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 430000, Hubei Province, China
Yong-Jun Chen, Department of Biliary-Pancreatic Surgery, Tongji Hospital, Wuhan 430030, Hubei Province, China
Bing Wang, Department of Hepatic-Biliary-Pancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Wan ML performed the literature search and drafted the manuscript; Chen YJ participated in manuscript drafting, formatting, revision, and institutional perspective; Wang B provided critical input on the intellectual content, and reviewed and revised the manuscript; and all authors have approved the final version of the manuscript.
AI contribution statement: An AI tool (DeepSeek) was used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Corresponding author: Bing Wang, PhD, Associate Chief Physician, Department of Hepatic-Biliary-Pancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 430030, Hubei Province, China. 2013tj0575@hust.edu.cn
Received: April 9, 2026 Revised: May 9, 2026 Accepted: July 1, 2026 Published online: September 27, 2026 Processing time: 159 Days and 16.9 Hours
Abstract
Pancreatic duct stones (PDS) are a prevalent and debilitating complication of chronic calcific pancreatitis, primarily driven by etiologies such as alcohol abuse and genetic factors. Their pathogenesis involves pancreatic inflammation, ductal obstruction, and subsequent precipitation of calcium carbonate, leading to ductal hypertension, abdominal pain, pancreatic exocrine/endocrine insufficiency, and recurrent acute exacerbations. Diagnosis relies on a multimodal imaging approach, which plays a pivotal role in not only detecting PDS but also in planning therapeutic strategies. Therapeutic strategies have evolved into a multimodal, stepwise approach. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, stone extraction, and stent placement remains a first-line minimally invasive option, demonstrating long-term pain relief in a significant proportion of patients and is applicable even in pediatric populations. For larger or impacted stones, extracorporeal shock wave lithotripsy (ESWL) is a critical adjunct. Evidence shows that ESWL coupled with same-session ERCP yields a higher stone clearance rate. Surgical intervention, including resection and drainage procedures, still plays a pivotal role for complex cases, such as those with large stones (> 0.5 cm) or associated ductal strictures where endoscopic methods may be insufficient. Key advances in clinical practice emphasize a tailored strategy based on stone characteristics (size, density, location) and ductal anatomy. The integration of ESWL with endoscopy, optimized by specialist collaboration and preoperative imaging assessment, enhances outcomes. Furthermore, the management of PDS requires a multidisciplinary framework involving endoscopists, surgeons, and radiologists to construct individualized treatment regimens that effectively alleviate pain, preserve pancreatic function, and improve quality of life.
Core Tip: This minireview comprehensively addresses pancreatic duct stones, a major complication of chronic pancreatitis. It covers pathogenesis and contemporary diagnostic evaluation, and provides a critical analysis of therapeutic strategies, including endoscopy, lithotripsy, and surgery. By integrating current evidence, it offers a framework for constructing individualized, stepwise treatment regimens to optimize patient management.
