The definitive treatment for intrahepatic bile duct stones is surgical resection, with the advantage of complete removal of the intrahepatic stones along with resolution of the associated biliary strictures. However, choledochoscopic stone extraction (percutaneous hepatic choledochoscopy or trans-T-tube) is an alternative to surgery for patients with high surgical risk, refusal of surgery or history of previous choledochotomy, and stones in multiple hepatic segments. The efficacy of such means has been previously reported to be established, but the relationship between biliary strictures and the prognosis of endoscopic stone extraction such as complete clearance rate, recurrence rate, and complication rate has not been clarified due to the variability of prognosis reported in some clinical trials. A recent Meta-analysis conclusively showed that strictures are the main cause of recurrence after treatment of intrahepatic bile duct stones. The overall complete clearance rates were 68.9% and 87.8% in the intrahepatic bile duct stenosis and non-stenosis groups, respectively, and the complete clearance rate was significantly lower in the stenosis group than in the non-stenosis group. The overall recurrence rates of intrahepatic stones/cholestasis were 52.4% and 27.2% in the biliary stenosis group and non-stenosis group, respectively, and the total recurrence rate was significantly higher in the stenosis group than in the non-stenosis group. The overall complication rates were 21.6% and 51.1% in the complete stone removal group and the non-complete removal group, respectively, and the overall complication rate was significantly lower in the complete stone removal group than in the non-complete removal group. The findings suggest that endoscopic lithotripsy is indeed a safe and effective method for the treatment of intrahepatic bile duct stones, in which bile duct stenosis is the main cause of recurrence and treatment failure, and therefore careful evaluation of the stenosis of the intrahepatic bile duct is initially necessary. In addition, several different methods such as balloon dilation and placement of catheters can be combined in order to completely remove the stones.