Clinical experience with biliary extracorporeal shock wave lithotripsy. Biliary lithotripsy is a new and important development in the nonsurgical management of gallbladder, cystic duct, and bile duct stones. Most patients do not require general or epidural anesthesia with newer second-generation machines. Patient selection and the use of adjuvant therapy to aid fragment clearance are important issues that are discussed. Results from different centers are compared but few long-term results are yet available, i.e., longer than 18 months. 