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Background: Endoscopic sphincterotomy (EPT) is well established as a treatment of bile duct stones, often performed to reduce the frequency of complications. We wanted to evaluate the complication rates after preventive cholecystectomy compared with expectative follow up., Material and Methods: In this retrospective study we have registered the outcome for 63 patients treated with cholecystectomy and 298 patients followed up expectatively. Allocation to the groups was based on clinical evaluation without randomization, hence the groups are not similar, a fact which should be taken into consideration when results are evaluated. For both groups we have registered events due to biliary complications., Results: The patients submitted to cholecystectomy were somewhat younger with higher comorbidity than the non-operated patients. In the expectative group, 27% had one or more late complications as opposed to 6.3% in the cholecystectomy group. There was no relative difference in mortality., Interpretation: The study confirms that prophylactic cholecystectomy may actually contribute to a lower complication rate and is an option for treatment in low-risk patients. Prophylactic cholecystectomy cannot, however, be recommended as a routine procedure. The study is based on clinically selected patient groups and results must be interpreted with care.