Pancreatic duct stone management strategies: Advances and clinical practice in chronic pancreatitis

Table 3 Summary of benefits and risks of direct intracorporeal lithotripsy techniques

Technique	Key benefits	Key risks/limitations
LL	High-precision, effective strategy for complex or ESWL-resistant stones. Allows fragmentation under direct visualization via POP. High pooled technical (88.1%) and clinical (81.6%) success rates. No ionizing radiation	Technically challenging and requires advanced endoscopic expertise. High cost and limited availability, restricted to specialized centers. Risks include pancreatic duct trauma, perforation, and PEP. Pooled adverse event rate for POP-guided lithotripsy is approximately 12%
EHL & electromechanical lithotripsy	Highly effective for fragmenting impacted main pancreatic duct stones. High technical success rate (e.g., 91.18% for POP-guided intracorporeal lithotripsy). Serves as a robust alternative or adjunct to other lithotripsy modalities	Efficacy is influenced by stone characteristics; high CT attenuation (> 2050 HU) or large diameter (> 12.8 mm) predict incomplete fragmentation. Requires precise electrode placement to avoid ductal wall contact, preventing barotrauma or perforation. Pooled adverse event rate is approximately 14.9%, with PEP being the most frequent complication (approximately 7%)

LL: Laser lithotripsy; ESWL: Extracorporeal shock wave lithotripsy; POP: Peroral pancreatoscopy; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; EHL: Electrohydraulic lithotripsy; CT: Computed tomography.