Objective. To work out the protocol and to assess the efficacy of endoscopic bile ducts sanation in patients with complicated gallstone disease in cases of presence of periampullary diverticulum. Material and methods. We have analyzed background of endobiliary procedures in 537 patients with complicated gallstone disease over the period of time from 2013 to 2016. Periampullary diverticulum was revealed in 141 (26.2%) patients. Patients were divided into two groups: I — 141 (26.2%) patients with complicated gallstone diseases and existence of periampullary diverticulum, II — 396 (73.8%) patients with complicated gallstone disease and with absence of periampullary diverticulum. 1st group comprised of 99 female (70.2%) and 42 male (29.8%) patients; mean age was 72.5 years. In the 2nd group were 280 female (70.5%) and 117 male (29.5%) patients; mean age was 64.3 years. Results. Transpapillary procedures in 136 patients (96.4%) of the 1st group with the presence of periampullary diverticulum were effective. In 5 cases (3.5%) of residual choledocholithiasis cannulation was unsuccessful that required accomplishment of the «rendez-vous» technique. Conclusion. In patients with gallstone disease complicated by distal choledochus obstruction presence of periampullary diverticulum was noted in 26.2% of cases. Existence of the least significantly complicates and sometimes even excludes the possibility of endoscopic restoration of bile leak due to challenges in visualization, cannulation of the papilla, risk of hemorrhage and retroduodenal perforation. Key elements of safe and effective papillary intervention in case of periampullary diverticulum are right positioning of the endoscope, constant focus of the papilla within sight, adequate equipment support and experience of the operator. In particularly difficult cases detection of the papilla in periampullary diverticulum can be eased by contrasting bile ducts or application of the «rendez-vous» technique.