We evaluated the role of biliary extracorporeal shock-wave lithotripsy in treating 70 symptomatic patients with bile duct stones in whom endoscopic or percutaneous radiologic attempts at basket extraction had failed. Forty-four patients had common bile and/or common hepatic duct stones, 21 patients had cystic duct stones, and five patients had intrahepatic duct stones. A total of 43 patients (61%) had complete elimination of stone fragments during the initial treatment period. If patients in whom stones were successfully fragmented yet not totally eliminated on initial hospital treatment but who were asymptomatic at follow-up times of 8-22 months are included, the overall successful treatment rate was 83%. Stones were cleared in 26 of 44 common bile/hepatic duct stone patients, spontaneously in seven patients and after endoscopic or percutaneous radiologic intervention in 19 patients. Fifteen (71%) of 21 patients had cystic duct stones successfully cleared. The fragments in two of five patients with intrahepatic duct stones also were cleared. Five patients (7%) had minor side effects. Seven (10%) of 70 patients went on to have surgery. Complications after 30 days occurred in five patients (7%); two required repeated endoscopy with fragment extraction, two required placement of an endoprosthesis, and one died. We conclude that biliary extracorporeal shock-wave lithotripsy is valuable as an adjuvant to standard interventional techniques for removing bile duct stones.