Purpose: Extracorporeal shock wave lithotripsy (ESWL) is an important tool for non-operative management of symptomatic pancreatic duct (PD) stones. Fragmentation of stones may permit endoscopic extraction at ERP thereby avoiding surgical intervention. First generation devices used water immersion and fluoroscopic targeting and became an integral adjunct in the non-operative management of painful chronic pancreatitis (CP). Second generation devices had self-contained water conducters and lower power profiles with ultrasound targeting but were ineffective for PD stones. LithoGold (Woodstock, GA) represents the third generation of ESWL with fluoroscopic targeting and a similar power profile to first generation devices. We aim to determine the safety and efficacy of this latest generation ESWL device on stone fragmentation and endoscopic management of painful CP. Methods: Retrospective chart review of all patients (pts) undergoing either first generation ESWL (fESWL) vs. LithoGold (LG) from 6/02 to 10/08 at UPMC. Outcomes included successful completion of ESWL, complications, clearance of the main PD at subsequent ERPs, improvement in symptoms, and number of pts ultimately requiring surgery. Results: 17 pts (8 fESWL, 9 LG) underwent therapy for symptomatic PD stones (mean age 54 years [range 40-76]; 11 males, 6 females). All pts underwent ERP prior to ESWL with placement of PD stent in 12/17. 8/8 successfully completed fESWL with mean of 1.9 treatments/pt (range 1-4) compared to 8/9 successfully completing LG with mean of 1.1 treatments/pt (range 1-2). A single failure occurred in the LG group due to interference of the spinal vertebrae with the shock wave despite oblique positioning of the pt. On average, 1150 shocks (range 800-2000) at 20 kV were administered with fESWL and 1670 shocks (range 1000-2750) at 24kV with LG. There were no complications in the fESWL group and only one case of transient hematuria in the LG group. Clearance of the PD at subsequent ERPs was reported in 7/8 (88%) pts with fESWL and 6/8 (75%) pts with LG. Initially, 7/8 (88%) pts in fESWL group and 6/8 (75%) pts in LG group reported symptom improvement after stone extraction. Ultimately, 3/8 (38%) in the fESWL group and 1/8 (13%) in the LG group required surgery. Conclusion: In our experience, LG is safe and effective with comparable results to fESWL for the treatment of symptomatic PD stones. The portability of the LG unit obviates the need for a specialized unit equipped with a water basin for fESWL. The disparity in surgical intervention may be attributed to longer follow-up in the fESWL group. Randomized studies are needed to determine the efficacy of third generation lithotriptors for treating PD stones.