**4. ESWL for pancreatic stones associated with pancreatic pseudo cysts and chronic pancreatitis**

A prospective study, by Li et al. [11], was performed on chronic pancreatitis patients with at least one stone in the main pancreatic duct of less than 5 mm in diameter. A total of 849 patients were divided into two groups: the case group was 59 patients with pancreatic stones and pancreatic pseudocysts (PPC) and the control group was 790 patients with pancreatic stones only. Following 116 ESWL sessions, 10.17% of patients in the PPC group showed com‐ plete stone clearance. Partial stone clearance occurred in 15.25% of patients. When ESWL was followed by ERCP, these percentages were raised to 67.24 and 20.69%, respectively. The authors concluded that ESWL—when followed by ERCP—was a successful strategy for lysis of pancreatic stones and regression of pancreatic pseudo cysts.

On the contrary, a retrospective study done by Vaysse et al. [12] has found that ESWL as a sole treatment—was proven a safe and effective treatment for patients with obstruct‐ ing stones in the main pancreatic duct. There was no need for adjuvant ERCP that showed no additional benefit. It was done on 146 patients with pancreatic duct stones resulting in chronic or recurrent acute pancreatitis. Only 132 patients continued to follow‐up at 6‐ month period. About 69% of patients received adjuvant ERCP. At the end of 6 months, 76% of patients achieved successful treatment in the form of no need for analgesia, no acute pancreatitis or no need for surgical treatment for chronic pancreatitis. There were no signifi‐ cant differences in success rates between patients who received ESWL alone and those who received adjuvant ERCP.
