Objective: To compare the clinical effects between laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) for common bile duct stones. Methods: The data of 210 patients with common bile duct stones treated between November 2012 and March 2014 were retrospectively analyzed. The patients were divided into LCBDE group (n=116) and EST group (n=94) according to the procedure they received, and the main clinical variables between the two groups were compared. Results: The surgical success rate had no significant difference between the two groups (99.1% vs. 95.74, P=0.175), but the one-stage cure rate in LCBDE group was significantly higher than that in EST group (97.4% vs. 90.4%, P=0.038), and there was no significant difference in residual stone rate, and the average length of hospital stay and hospitalization costs between the two groups (all P>0.05), but in EST group, 9 cases underwent second EST, and 6 cases underwent third EST after the first-stage treatment due to residual stones, and the length of hospital stay and medical expenses were markedly increased in these cases with first treatment failure. The incidence of perioperative complications and long-term complications in LCBDE group was significantly lower than that in EST group (both P<0.05), due to the relatively high incidence of the EST-related complications of the latter. Conclusion: For common bile duct stones, the one-stage cure rate of LCBDE is higher than that of EST, with less incidence of complications and preservation of the function of the sphincter of Oddi. In addition, laparoscopic cholecystectomy can be simultaneously performed to solve the gallbladder problems during LCBDE. Thus, it should be considered as the first choice of option in most cases.