Abstract： Objective To probe the indication,treatment algorithm,anesthesia method,safety and efficacy of extracorporeal shockwave lithotripsy (ESWL) in combination with endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct stones.Methods The patients with chronic pancreatitis and large pancreatic duct stones ( ＞ 5 mm diameter) and receiving ESWL and ERCP between March and July 2011 in Changhai Hospital were prospective studied.The third generation of extracorporeal shockwave lithotripsy was applied in ESWL,and the localization of stone was determined by X-ray.No more than 5000 shocks were given per session,and ESWL was performed continuously till the calculi were fragmented,and then was cleared by ERCP.Results A total of 100 patients underwent ESWL during the 5 months,among whom 84 patients received ERCP treatment and 41 cases failed to deep cannulation (41/84,48.8％ ).Multiple stones were seen in 83 patients.Ninety five patients had radio-opaque stones,two patients had radiolucent calculi,while three patients had both radio-opaque and radiolucent stones.Seventy five percent,14％ and 11％ stones were located in pancreatic head,pancreatic head and body,pancreatic body and tail,respectively.A total of 175 ESWL procedures were performed,43 patients needed 2 or more sessions for successful fragmentation.Anesthesia method was mainly intravenous sedation,accounting for 96％ (168/175).ERCP was successful in 96 patients after ESWL,only 4 patients failed after ESWL. Forty one cases which failed ERCP procedures before ESWL underwent ERCP,and 37 patients (90.2％) achieved successful cannulation.Successful fragmentation rate was 100％.Complete clearance was achieved in 78 patients,and complication rate of post-ERCP pancreatitis,fever was 1.71％ (n =3 ),0.57％ (n =1 ),and the overall complication rate was 2.28％.Conclusions ESWL is an effective,safe and necessary modality for fragmentation of large PD stones in the management of minimal invasive treatment of chronic pancreatitis.