BACKGROUND Endoscopic retrograde intracorporeal lithotripsy with a stone recognition laser system seems to be a promising alternative in patients with difficult bile duct stones. METHODS Sixteen patients with bile duct stones not suitable for endoscopic standard procedures underwent intracorporeal laser lithotripsy during a 3-month period. An average of 6800 (120 to 25000) discharges were applied with a power setting of 100 mJ. Inserting the laser fiber into a radiopaque marked catheter or into a balloon catheter guaranteed a successful location on the stone surface in 70% of all discharges. The automatic feedback/cut-off at the fiber is not in contact with the stone surface. RESULTS Fragmentation was achieved in all cases. Complete bile duct clearance was reached in 14/16 cases. In two cases, remaining fragments passed spontaneously through the papilla as controlled by ERCP. Minor complications were noted in two patients (hemobilia, cholangitis). Complete recovery was achieved in both patients with conservative management. CONCLUSIONS For a selected group of patients with difficult common bile duct stones, intracorporeal laser lithotripsy with a stone recognition laser system was found to be a highly effective and safe technique.