George Philips presented a paper on the use of lithotripsy for the treatment of pancreatic stones by Milovic et al (PMID: 21981815). This was a series of 32 patients who had failed ERCP and were treated with lithotripsy  at one German center between 2000 and 2003. Patients underwent a median of four sessions of lithotripsy, and some patients underwent as many as 15 sessions. ERCP was subsequently performed. 40% of patients had clearance of the pancreatic duct, and the other 60% required stent placement (and change-outs). At 6-9 months, 87% of patients reported some improvement in their pain. A major limitation of the study was the simplicity of the pain and quality of life scales (rated each as 1-5), which were not validated. Without a randomized control trial design, the improvements in pain were difficult to judge due to potential placebo effect. However, lithotripsy could be used to delay or avoid surgery in certain patients. In the past, this has been available at Duke, and is something that might be worth revisiting.