In high risk but operable patients, endoscopic papillotomy (EPT) is a useful treatment in cases with choledocholithiasis and with papillary stenosis. The risk of the procedure is lower than by surgical intervention Complications can occur in 7.3%, most of them within 24 h. The mortality rate was 1.7% and depends on the precise selection of the patients; on the knowledge of the postpapillotomy treatment and on the experience of the examiner. This procedure should be limited to centers with well trained and experienced endoscopists.