During a four-year period endoscopic biliary drainage (EBD)--preoperative in 25 and permanent in 45 patients--was successfully established without sphincterotomy in 70 out of 89 referred patients (79%) with malignant bile duct obstruction. 51 of the patients had internal stents and 19 external naso-biliary tubes. There was no procedure-related mortality or severe complications such as perforation or bleeding. One patient, however, got a moderate pancreatitis after stent drainage (1%). In the early drainage period (before operation or discharge) the cholangitis rate was 10%, and during the late period (after discharge) it rose to 27% of the patients. 68 of all 70 patients (94%) had a reduction in S-bilirubin concomitant with clinical improvement and 27 of the 45 patients (59%) with permanent drainage became unjaundiced. Recurrent or increasing jaundice occurred, however, in half the number of these patients (23/45) after an average of 89 days; twelve of them had a temporary regression of jaundice after exchange of stents in spite of advanced disease. The use of multiple stents did not reduce the risk of recurrent jaundice or of cholangitis. It is concluded that EBD inserted without sphincterotomy is a safe and efficient non-surgical alternative in the treatment of malignant bile duct obstruction.