Objective To evaluate the efficacy and safety of endoscopic papillary balloon dilation （EPBD）combined with endoscopic sphincterotomy（EST）for the treatment ofnon ⁃ dilated extrahepatic bile duct stones（Non⁃DEBDS）. Methods The clinical data of patients with dilated extrahepatic bile duct stones（DEBDS） and NDEBDS treated with endoscopic retrograde cholangiopancreatography（ERCP）were collected and analyzedto compare the efficacy and safety of ERCP between the two groups. According to the therapies they received，the patients with non⁃dilated extrahepatic bile duct stones were divided into EPBD group（n = 75），minor EST group （n = 75），and minor EST combined with EPBD（EST⁃EPBD）group（n = 87），and the efficacy and safety of the three groups were evaluated. Results The DEBDS group was less likely to develop with hyperamylasemia（HP）and post⁃ERCP pancreatitis（PEP）than the Non⁃DEBDS group within one week after surgery（P < 0.05），some cases developed with mild or moderate pancreatitis，but none with severe conditions. All the treatment methods were effective for clearing the stones completely in the non⁃DEBDS patients（P > 0.05）. The pairwise comparison results showed that the incidences of HP and PEP in the EPBD group were both higher than in other groups，respectively （P < 0.05）. Conclusion The endoscopic papillary balloon dilation combined with endoscopic sphincterotomy achieves a better effect in treatment of non⁃dilated extrahepatic bile duct stones，with lower incidences of PEP and HP. It is of higher value clinically in terms of reduced operation and surgical costs.