{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:24:56Z","timestamp":1782602696874,"version":"3.54.5"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,27]],"date-time":"2017-07-27T00:00:00Z","timestamp":1501113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>The main treatment aim in chronic pancreatitis (<jats:styled-content style=\"fixed-case\">CP<\/jats:styled-content>) is symptom control and especially pain relief. Management of stone\u2010predominant <jats:styled-content style=\"fixed-case\">CP<\/jats:styled-content> is challenging and requires a multidisciplinary approach. Extracorporeal shock wave lithotripsy (<jats:styled-content style=\"fixed-case\">ESWL<\/jats:styled-content>) has emerged as the cornerstone of non\u2010surgical treatment as a result of disappointing results of available endoscopic treatment options during the last decades. With new developments in the field of direct peroral pancreatoscopy (<jats:styled-content style=\"fixed-case\">POP<\/jats:styled-content>) and intracorporeal lithotripsy, direct intraluminal treatment of main pancreatic duct (<jats:styled-content style=\"fixed-case\">MPD<\/jats:styled-content>) stones returns to the spotlight.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Herein, we reviewed the current data on direct pancreatoscopic treatment of <jats:styled-content style=\"fixed-case\">MPD<\/jats:styled-content> stones with a focus on efficiency and safety of available technologies, endoscopes and lithotripsy devices. A systematic Medline search for relevant studies was done.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten relevant publications meeting the inclusion criteria were identified (two prospective series, six retrospective trials, two case reports, <jats:italic>n<\/jats:italic>\u00a0=\u00a087 patients). Successful ductal clearance for <jats:styled-content style=\"fixed-case\">POP<\/jats:styled-content>\u2010guided treatment was reported as between 43% and 100% compared to <jats:styled-content style=\"fixed-case\">ESWL<\/jats:styled-content> with 59% to 80%. Adverse event rate for <jats:styled-content style=\"fixed-case\">POP<\/jats:styled-content>\u2010guided therapy was reported as 0\u201313.5%. One study showed a noticeable higher adverse event rate of 43%. In this trial, <jats:styled-content style=\"fixed-case\">POP<\/jats:styled-content> was carried out after <jats:styled-content style=\"fixed-case\">ESWL<\/jats:styled-content>. There is no reported mortality following <jats:styled-content style=\"fixed-case\">POP<\/jats:styled-content> treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Available results are promising in terms of ductal clearance and pain relief compared to standard endoscopic techniques and <jats:styled-content style=\"fixed-case\">ESWL<\/jats:styled-content> as the current gold standard for lithotripsy. Interpretation of this data is limited by the small number of cases for <jats:styled-content style=\"fixed-case\">POP<\/jats:styled-content> and the lack of prospective randomized controlled trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.12909","type":"journal-article","created":{"date-parts":[[2017,6,28]],"date-time":"2017-06-28T08:12:43Z","timestamp":1498637563000},"page":"29-37","source":"Crossref","is-referenced-by-count":53,"title":["Endoscopic treatment of pancreatic duct stones under direct vision: Revolution or resignation? 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