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. · For planned cesarean, universal PPE is cost saving..Background intends Per-oral cholangioscopy with intraductal lithotripsy facilitates optically-guided rock fragmentation of difficult biliary stones refractory to old-fashioned endoscopic treatment. The aim of this study was to assess the efficacy and protection of per-oral cholangioscopy with intraductal lithotripsy for difficult biliary rocks. Methods Searches of PubMed, EMBASE, internet of Science, and Cochrane data