Objective To compare the clinical effects on elderly patients suffered from gallbladder stones associated with choledocholithiasis between the group of laparoscopic cholecystectomy(LC) with common bile duct exploration (LCBDE) using three scopys including laparoscopy, cholangioscopy and duodenoscopy and the group of endoscopic sphincterotomy(EST) with LC. Methods Sixty elderly patients more than 65 years with stones in gallbladder and common bile duct had common bile duct diameter 10 mm and more in our hospital between March 2018 and June 2019 and were analyzed retrospectively. Thirty-five cases had LC and LCBDE with primary duct closure combined with biliary stent. Twenty-five cases were treated EST with LC. Clinical effects were compared between two groups. Results There was no significant difference in postoperative hospital stay, pancreatitis, biliary bleeding, pulmonary infection and stone recurrence, biliary tract infection between two groups. However, the differences were significant in operative time, hospital cost and postoperative hyperamylasemia between two groups. Conclusions The stones in gallbladder and common bile duct in elderly patients could be treated by LC, LCBDE and primary duct closure combined with biliary stent, which had better clinical effects when compared to EST and LC.