Targeted endoscopic approaches offer symptom relief in chronic pancreatitis but surgery is preferred for long-term outcomes.

• Endoscopy is effective for small pancreatic duct stones; larger stones require extracorporeal shock wave lithotripsy or pancreatoscopy.
• Main pancreatic duct strictures should be treated with dilation and single large-caliber plastic stents; avoid fully covered metal stents due to higher risks.

Surgery remains the gold standard for durable pain control and improved quality of life in select patients.

• Endoscopic ultrasound-guided celiac plexus block provides short-term pain relief for refractory cases.