Approximately 80% of common bile duct stones can be removed endoscopically by using standard endoscopic basket or balloon extraction techniques. The addition of mechanical lithotripsy has improved success rates by another 10%. Intraductal lithotripsy with electrohydraulic or laser technology has enabled success rates to approach 100%. Endoscopic stent placement is a last resort measure that should be reserved for patients with difficult stones who cannot tolerate intraductal shock wave lithotripsy. High equipment costs for intraductal lithotripsy and the need for cholangioscopic guidance has restricted this technology to a few specialized centers around the world. The recent development of a pulsed laser with an automated stone recognition system eliminates the need for cholangioscopic guidance and has shown promising results in preliminary studies. However, lithotripsy performed under fluoroscopic guidance seems to be less effective than when performed under direct vision. Comparing the currently available modalities for cholangioscopic guided lithotripsy, electrohydraulic lithotripsy has advantages of being the most economical, practical (eg, small generator size, portable, no special outlets), and effective.