Pancreatic extracorporeal shock wave lithotripsy (P-ESWL), a non-invasive treatment, is widely accepted worldwide as the preferred option for pancreatic duct stone (PDS) treatment. P-ESWL provides significant relief of painful symptoms and improves patients’ quality of life through efficient lithotripsy and catheter removal. Although there is risk of post-operative complications such as pancreatitis, the overall incidence is low and can be further minimized by effective management strategies. It is worth noting that computed tomography-based quantitative analysis and radiomics prediction model provide a scientific basis for personalized P-ESWL, heralding more precise and efficient treatment in the future. P-ESWL for treating PDS will be further improved by future multi-center and large-sample studies, as well as by the integration of artificial intelligence and machine learning algorithms, which may lead to significant therapeutic effects and improvements in patients’ quality of life.