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Summary: Background and Aims: Extracorporeal shock wave lithotripsy for pancreatic stones (P‐ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferred therapeutic approaches for painful chronic pancreatitis (CP) with pancreatic stones. This study aimed to report the short‐ and long‐term outcomes following P‐ESWL and ERCP in a large cohort with CP. Methods: Patients with painful CP and pancreatic stones >5 mm in size, who underwent P‐ESWL and subsequent ERCP between March 2011 and June 2018, were included in this retrospective‐prospective mixed observational study. The total stone clearance rates were recorded. All patients were followed up until the end of March 2024, with the visual analogue scale (VAS) for pain, pain type, quality‐of‐life scores and other relevant information recorded. Results: A total of 2071 patients underwent P‐ESWL, and 93.1% of them subsequently underwent ERCP during the study period. Patients were followed up for an average of 11.8 years from the onset of CP and 6.7 years from the first P‐ESWL procedure. Complete stone clearance was achieved in 73.7% of the patients. At the end of the follow‐up period, 70.1% of the patients achieved complete pain remission. Significant pain type conversion and lower VAS scores were observed in the patients after treatment. Quality‐of‐life scores and body mass indices increased after P‐ESWL and ERCP. Conclusions: P‐ESWL and ERCP are effective and minimally invasive treatments for pancreatic stones in patients with painful CP. Most patients achieved complete pain relief, and pain‐type conversion was common after treatment. (ClinicalTrials.gov: NCT05916547). [ABSTRACT FROM AUTHOR]