Stone retention after duodenoscopic sphincterotomy may occur despite an adequate and well-performed sphincterotomy. We have identified factors contributing to stone retention in 26 patients. In 22 of these patients, the stones have been effectively managed with a biliary endoprosthesis in a manner which traps the stone proximally and maintains patency of the biliary tree. No complications were noted with this form of management for periods ranging form 3-36 months. When circumstances preclude removal of bile duct stones after duodenoscopic sphincterotomy, a biliary endoprosthesis offers a safe, effective means of stone management.