1 Recommendations

1 Recommendations


Clinicians wishing to do electrohydraulic lithotripsy for difficult-to-treat bile duct stones should:

  • Inform the clinical governance leads in their healthcare organisation.

  • Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.

  • Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.

  • Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).

  • Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.


Healthcare organisations should:

  • Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.

  • Regularly review data on outcomes and safety for this procedure.


The procedure should only be done in specialised centres with experience of managing difficult-to-treat bile duct stones.


Patient selection should be done by a multidisciplinary team including a hepatobiliary surgeon and clinicians with expertise in endoscopic retrograde cholangiopancreatography.

  • National Institute for Health and Care Excellence (NICE)