Pancreatic pathology encompasses a broad differential and requires a multitude of diagnostic studies to accurately diagnose a specific condition. ERCP has been shown to be extremely helpful and accurate in the diagnosis and treatment of pancreatic ductal disease. However in the event in which pancreatography reports conflicting data, additional work-up should be considered with pancreatoscopy which allows for the direct visualization of the pancreatic duct. Its utility in this situation has been previously demonstrated in the literature with discrepancies on ERCP and CT imaging. We present a case in which a patient had been diagnosed with a pancreatic stricture by ERCP was ultimately found to have stone disease using pancreatoscopy. A 72-year-old female with no significant past medical history presented to the hospital with complaints of abdominal pain radiating to her back accompanied by nausea and vomiting. Laboratory studies noted a lipase of 6,570U/L with normal liver function tests. An abdominal contrast-enhanced CT reported a 5mm pancreatic duct (PD) stone within the mid-PD causing acute distal pancreatitis without evidence of gallstones or biliary dilation which was confirmed via ultrasound. The patient failed conservative management and thus underwent endoscopic intervention with an ERCP. A pancreatogram noted a stricture within the mid-PD (Figure 1) without the presence of a stone. Thus an internal flanged external pigtail stent was placed spanning the stricture. Her symptoms gradually improved. Approximately 4 weeks later, repeat endoscopic evaluation was performed to evaluate for an underlying malignant pathology. Endoscopic ultrasound (EUS) failed to note any intraparenchymal pancreatic disease. A repeat ERCP was performed and her stent was removed. A pancreatoscopy then was performed which discovered an obstructing stone within the mid-PD (Figure 2). A balloon catheter was unable to be passed, thus the stone was fragmented using electrohydraulic lithotripsy (EHL) and the PD was subsequently swept clean. A stent was replaced, and is currently scheduled for removal in 8 weeks. Within the large realm of pancreatic medicine, there are multiple modalities which exist to accurately diagnose pancreatic pathology. When faced with conflicting evidence between imaging results, especially involving ductal disease, performing a pancreatoscopy is a great diagnostic tool which may help guide the management of patients with undiagnosed disease.1309_A.tif Figure 1: Pancreatogram revealing a stricture within the mid-pancreatic duct. No filling defects are noted.1309_B.tif Figure 2: Pancreastoscopy noting an obstructing mid-pancreatic duct stone.