Individuals who are susceptible to alcohol injury of the pancreas develop blockage of the pancreatic duct and frequently get dilation of the pancreatic duct and form stones within the duct. This can be treated with the Puestow procedure. Stones in the head of the pancreas can be broken up with shock waves that are delivered to the stones under direct vision with a flexible scope placed in the pancreatic duct at the time of surgery. The Frey procedure and the Whipple procedure are also used in treating alcohol injury to the pancreas when the head of the pancreas is the site of most of the disease.