Pancreatoscopy guided lithotripsy for difficult pancreatic duct stones: Evidence and treatment selection in chronic pancreatitis

Figure 2 Representative pancreatoscopy-guided lithotripsy workflow. A: Direct pancreatoscopy shows an obstructing pancreatic duct stone within the main pancreatic duct; B: A laser fiber or electrohydraulic lithotripsy probe is positioned against the stone under direct visualization; C: Controlled intraductal lithotripsy achieves progressive stone fragmentation; D: Residual fragments are cleared, and associated downstream ductal stricture is managed with dilation and/or temporary pancreatic stenting when required.