Endoscopic sphincterotomy was attempted in 81 patients with gallbladders for the primary management of symptomatic common duct stones and was successful in 80. Immediate complications occurred in six (7 per cent) and one patient died (1 per cent). Clearance of the common duct was achieved in 70 (86 per cent). Eight patients required surgery for failed clearance of the duct and suffered no operative mortality. Of 70 patients with cleared ducts, 5 underwent elective cholecystectomy. Four other patients with persistent or recurrent symptoms have required cholecystectomy, also without mortality. Sixty-one patients were reviewed 12-44 months (mean 24; median 22 months) after endoscopic sphincterotomy. Eighteen have died, none from biliary disease. Forty-three patients remain alive and well, free of biliary symptoms since, endoscopic sphincterotomy. When the surgical risk of cholecystectomy and choledocholithotomy is high, endoscopic sphincterotomy is effective and safe. Routine cholecystectomy is not indicated when the common duct has been cleared.