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Background Borderline Size common bile duct stones (BLS-CBDS) are associated with hepatopancreato-biliary morbidity and complications. Its optimum management is still controversial till now. Aim Is to compare conservative treatment versus endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of BLS-CBDS. Material and methods This retrospective study included patients with BLS-CBDS less than or equal to 10mm who were treated conservatively or by ERCP endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). The primary outcome was successful common bile duct (CBD) clearance, and the secondary outcomes were complications, impact on laparoscopic cholecystectomy, and hospital stay. Results Out of 270 patients, 150 were treated by ERCP and 120 by the Conservative approach. There was complete clearance of CBDS in 75 (50%) patients out of 150 patients in the ERCP group and useless procedure in the remaining 75 (50%) patients. In the conservative group, there was complete clearance of CBDS in 99 (82.5%) cases, and useless in the remaining 21 (17.5%) patients. Post-ERCP pancreatitis occurred in 33 (22%) patients. Conclusion BLS-CBDS increases the technical difficulty of ERCP and the risk of post-ERCP pancreatitis. Conservative management of CBDS is effective in clearing CBDS, it should be considered to avoid unnecessary ERCP and its complications. [ABSTRACT FROM AUTHOR]