Background:Electrohydraulic lithotripsy is a highly effective method for fragm enting biliary stones,butdirectvisual control is required.The efficacy and the safety of electrohydraulic lithotripsy without cholangioscopy by using a balloon catheter were evaluated in patients with bile-duct stones thatcould notbe extracted by using standard techniques. Methods: Nineteen patients with extrahepatic bile-duct stones that could not be extracted by using conventionalendoscopic methods,e.g.,mechanical lithotripsy,were selected to undergo electrohydraulic lithotripsy without peroral cholangioscopy. An electrohydraulic lithotripsy probe with a 3.0F radio-opaque tip was inserted through a balloon catheter.Electrohydraulic lithotripsy was performed under fluoroscopy until the fragm ented stone could be captured in a large basket for mechanical lithotripsy.Endoscopic removal of the fragments was attempted during the electrohydraulic lithotripsy session. Results:Stones were successfully fragm ented in 17of 19 patients.In 16patients (84.2% ),the bile duct was cleared ofallstones.A mean of 1.8endoscopic sessions was required for com plete removal.Additional mechanical lithotripsy wasperformed in 9(56.2%)of the 16patients. Minorcom plications were noted in 4patients (2hem obilia, 1pancreatitis,1cholangitis).There was no 30day mortality.Conclusions:For a selected group of patients with bile-duct stones not extractable by using standard techniques, fluoroscopically controlled electrohydraulic lithotripsy with a balloon catheter seems to be an effective method offragmentation. Background: Electrohydraulic lithotripsy is a highly effective method for fragm enting biliary stones, butdirectvisual control is required. The efficacy and the safety of electrohydraulic lithotripsy without cholangioscopy by using a balloon catheter were evaluated in patients with bile-duct stones that can not be extracted by using standard techniques. Nineteen patients with extrahepatic bile-duct stones that could not be extracted by using conventionalendoscopic methods, eg, mechanical lithotripsy, were selected to under electrohydraulic lithotripsy without peroral cholangioscopy. An electrohydraulic lithotripsy probe with a 3.0F radio-opaque tip was inserted through a balloon catheter. Electrohydraulic lithotripsy was performed under fluoroscopy until the fragm ented stone could be captured in a large basket for mechanical lithotripsy. Endoscopic removal of the fragments attempted during the electrohydraulic lithotripsy session. Results: Stones were successfully fragm ented A mean of 1.8 endoscopic sessions was required for com plete removal. Additional mechanical lithotripsy was formed in 9 (56.2%) of the 16 patients. Minorcomces were treated as 16patients (84.2%), the bile duct was cleared ofallstones. A mean of 1.8 endoscopic sessions was required for com plete removal. in 4patients (2 hem obilia, 1 pancreatitis, 1 cholangitis). There was no 30 day mortality. Conclusions: For a selected group of patients with bile-duct stones not extractable by using standard techniques, fluoroscopically controlled electrohydraulic lithotripsy with a balloon catheter seems to be effective method offragmentation.