EUS-guided pancreaticogastrostomy followed by pancreatoscopy is effective for managing pancreatic head duct stones.

• 95% technical success rate for EUS-guided pancreaticogastrostomy in 20 patients.
• Complete stone clearance achieved in 89% of those treated with subsequent pancreatoscopy-guided lithotripsy.

This method is safe, with only mild early adverse events and a 6% recurrence rate.

• No late adverse events were reported, supporting EUS-pgs as a reliable first-line intervention.