BACKGROUND Endoscopic sphincterotomy (EST) and stone extraction are established therapeutic procedures for common bile duct (CBD) stones. Little is known about the outcomes of EST for CBD stones among elderly patients. OBJECTIVE To examine the rate and the risk factors (CBD dilation and/or angulation, periampullary diverticulum, and past open cholecystectomy) for recurrent symptomatic CBD stones after EST in the elderly. METHODS A total of 228 patients who underwent EST for CBD stones in the period 1997 to 2004 were included. Follow-up data were obtained from medical records and by questioning all the patients. The correlation between age and stone recurrence, as well as between age and the prevalence of risk factors for recurrence was calculated. In addition, a subgroup of 45 elderly patients aged > or =80 years was compared with a control subgroup of 51 young patients aged < or =50 years, in terms of stone recurrence and associated risk factors. METHODS Single-center, retrospective study. METHODS Endoscopic sphincterotomy. METHODS Symptomatic CBD stone recurrence rate and frequency of risk factors for it. RESULTS In the group of all patients, a correlation was found between the age and stone recurrence, as well as between age and the known risk factors for recurrent stones. In analyzing the 2 subgroups, CBD stones recurred in 20% of the elderly patients compared with 4% of the young patients. Risk factors for recurrent CBD stones were more common in the elderly, and so was the presence of multiple risk factors in the same patient. CONCLUSIONS Recurrence of symptomatic CBD stones after endoscopic therapy was more frequent in the elderly patients because of an increased frequency of risk factors.