After carefully examining the latest research by Liu et al. on the treatment of pancreatic duct stones [1]. We believe the study overlooked some key factors that could affect the accuracy and interpretation of the results.

Firstly, the study did not specify whether patients with a history of pancreatic surgery, diagnosis of pancreatic cancer, pain conditions other than chronic pancreatitis, long-term use of opioid analgesics, pancreatic head mass, multiple strictures, significant ascites, and/or large fluid collections were excluded, which were focal points in previous research [2, 3]. A history of pancreatic surgery may alter pancreatic anatomy, thereby affecting pancreatic fluid flow and ductal pressure, which could influence the efficacy and risk of complications from P-ESWL and ERCP. A diagnosis of pancreatic cancer is a critical exclusion criterion, as patients with cancer may require different pain management and treatment strategies. Conditions of pain other than chronic pancreatitis and long-term opioid use could affect the assessment of pain and judgement of treatment efficacy. Moreover, the presence of a pancreatic head mass, multiple strictures, significant ascites, and/or large fluid collections may indicate the severity and complexity of the disease, which could affect the applicability and outcomes of P-ESWL and ERCP.

Secondly, the study did not specifically record and adjust for the concurrent presence of pancreatic pseudocysts (PPCs). PPCs occur in approximately 20%–40% of patients with chronic pancreatitis and are often associated with large intraductal stones [4], likely due to increased ductal pressure caused by stones and/or strictures. The presence of PPCs may be closely related to chronic pain and recurrent episodes of acute pain, posing a challenge to clinical management. Not accounting for the coexistence of PPCs could introduce confounding and limitations to the study's conclusions. PPCs may require additional interventions, such as cyst drainage or surgical intervention, which, if not recorded, could be overlooked in the study [5].

Lastly, the study did not clearly record and adjust for the total number of ERCPs following P-ESWL and the total number of ESWL sessions. This information is crucial for a comprehensive evaluation of the efficacy and safety of P-ESWL and ERCP in treating pancreatic duct stones in patients with chronic pancreatitis [2, 6]. The number of ERCPs post-P-ESWL reflects the complexity of treatment and the severity of the patient's condition, with multiple ERCPs possibly indicating the need for additional interventions to clear stones or manage complications, which could affect the patient's recovery process and long-term prognosis. The total number of ESWL sessions is an important indicator of treatment intensity and patient response to initial therapy, with patients requiring multiple ESWL sessions possibly having more challenging stones, necessitating more complex treatment strategies and closer monitoring. Additionally, the study did not record and adjust for the interval between the diagnosis of chronic pancreatitis and P-ESWL, which are significant risk factors for major complications of P-ESWL [7]. Pancreatic divisum's influence on post-P-ESWL complications and the unaccounted interval from chronic pancreatitis diagnosis to treatment may obscure the study's findings on P-ESWL efficacy and risks. Addressing these factors is critical for robust scientific conclusions.

在仔细研究了 Liu 等人关于胰管结石治疗的最新研究后 [1]。我们认为该研究忽略了一些可能影响结果准确性和解释的关键因素。

首先，该研究没有具体说明是否有胰腺手术史、胰腺癌诊断、慢性胰腺炎以外的疼痛状况、长期使用阿片类镇痛药、胰头肿块、多发性狭窄、严重腹水和/或大量积液的患者被排除在外，这些都是以前研究的重点 [2， 3].胰腺手术史可能会改变胰腺解剖结构，从而影响胰液流动和胰管压力，从而影响 P-ESWL 和 ERCP 并发症的疗效和风险。胰腺癌的诊断是一个关键的排除标准，因为癌症患者可能需要不同的疼痛管理和治疗策略。慢性胰腺炎以外的疼痛状况和长期使用阿片类药物可能会影响疼痛的评估和治疗效果的判断。此外，胰头肿块、多发性狭窄、明显腹水和/或大量积液可能表明疾病的严重程度和复杂性，这可能会影响 P-ESWL 和 ERCP 的适用性和结局。

其次，该研究没有专门记录和调整胰腺假性囊肿 （PPC） 的并发存在。PPC 发生在大约 20%-40% 的慢性胰腺炎患者中，并且通常与大的导管内结石有关[4]，可能是由于结石和/或狭窄引起的导管压力增加。PPCs 的存在可能与慢性疼痛和急性疼痛的反复发作密切相关，对临床管理构成挑战。不考虑 PPC 的共存可能会给研究的结论带来混淆和局限性。PPC 可能需要额外的干预措施，例如囊肿引流或手术干预，如果未记录，则可能在研究中被忽略 [5]。

最后，该研究没有明确记录和调整 P-ESWL 后 ERCP 的总数和 ESWL 会话的总数。这些信息对于全面评价 P-ESWL 和 ERCP 治疗慢性胰腺炎患者胰管结石的疗效和安全性至关重要 [2， 6]。P-ESWL 后 ERCP 的数量反映了治疗的复杂性和患者病情的严重程度，多个 ERCP 可能表明需要额外的干预措施来清除结石或管理并发症，这可能会影响患者的康复过程和长期预后。ESWL 疗程总数是治疗强度和患者对初始治疗反应的重要指标，需要多次 ESWL 疗程的患者可能患有更具挑战性的结石，需要更复杂的治疗策略和更密切的监测。此外，该研究没有记录和调整慢性胰腺炎诊断与 P-ESWL 之间的间隔，而 P-ESWL 是 P-ESWL 主要并发症的重要危险因素 [7]。胰腺分裂对 P-ESWL 后并发症的影响以及从慢性胰腺炎诊断到治疗的未解释间隔可能掩盖了该研究对 P-ESWL 疗效和风险的研究结果。解决这些因素对于得出可靠的科学结论至关重要。