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Endoscopic shock-wave lithotripsy (ESWL) and endoscopic procedures are useful treatment for symptomatic patients with pancreatic stones distributed in the main pancreatic duct. When pancreatic exocrine function can be preserved by removing the stones, even patients without pain can benefit. In patients with large or multiple stones, following ESWL with endoscopic treatment may reduce duration of the course treatment. Reported stone clearance rates range from 42% to 89%, pain relief rates from 15% to 91.1%, and recurrence rates from 12% to 22%. Recurrence is among the most important problems encountered with non-surgical treatment. In several studies, recurrence was observed in about 20% of patients, sometimes requiring surgery. Non-surgical treatment is safe. ESWL combined with endoscopic treatment is the usual first option for pancreatolithiasis, largely limiting the need for surgery to patients with treatment failure or multiple recurrences.