Brewer Gutierrez OI, et al. - The safety and effectiveness of digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy in an international, multi-center study of patients with difficult biliary stones were explored in this study. In a multi-center, international, retrospective investigation, they found D-SOC with electrohydraulic or laser lithotripsy to be successful and safe in over 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.