In 9 cases of choledocholithiasis and 2 cases of endoscopically determined stenosis of the papilla in which an EPT could not be successfully performed it was possible to carry out a prepapillary choledochoduodenal fistula by means of endoscopy. Subsequently the fistula was split in the cranial direction using a papillotome, i.e. a fistulotomy was performed. The choledochal concrements disappeared spontaneously and the patients recovered successfully. In 4 further cases with an occlusion icterus, but with narrow ductus choledochus the common bile duct could not be cannulated. The endoscopic fistulotomy is only indicated when the common bile duct is dilated and if prior to the procedure and after failure of ERCP the indication for a surgical intervention is established through sonography or even better through PTC.