Background and aims: Intrahepatic lithiasis (IHL) is prevalent in East Asia, but relatively uncommon in Western societies. Bile stasis or biliary infections can lead to stone formation; strictures or dilations are often encountered in association with IHL. Treatment can be difficult and includes a surgical, percutaneous or endoscopic approach. The main objective of treatment is the complete removal of stones. The aim of this study is to assess the role of Electromagnetically generated extracorporeal shock waves lithotripsy (ESWL) associated with the endoscopic retrograde treatment of intrahepatic lithiasis. Patients and Methods: From November 1987 to April 2002, 215 patients (122 male, mean age 57.3, range 19-91) with intrahepatic lithiasis underwent endoscopic retrograde colangiography and stone extraction. A second generation extracorporeal shock wave lithotriptor (Siemens-Lithostar Plus: Erlangen, Germany) has been used since 1994 to achieve fragmentation of stones that could not be cleared during ERCP. Premedication of patients for ESWL treatment included sedation with diazepam (5-10 mg i.v.), morphine (5-10 mg i.v.), Ketoprofene (50-100 mg i.v.). All procedures were performed under fluoroscopy after insertion of a naso-biliary drainage. Patients were divided retrospectively in 2 groups: patients treated before 1994 (Group 1) and after 1994 (Group 2). Case-control analysis was performed between the 2 groups comparing ESWL rate and stone extraction success rate and for the evaluation of patients with congenital and post-operative strictures. Results: see the table. Conclusions: ESWL is a useful technique in the treatment of IHL. Associated to ERCP it significantly increases the complete stone extraction success rate. It seems to be effective also in patients with congenital or post-operative strictures even if the small group does not produce a statistically significant difference.