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Background The aim of this study was to examine the relation between periampullary diverticula (PAD) and biliary tract stones Methods A total of 732 cases of patients with PAD identified from among 6,221 patients who underwent endoscopic retrograde cholangiopancreatography were compared to 750 controls (without PAD) in terms of biliary stone formation, incidence of sphincter of Oddi dysfunction (SOD), and choledocholithiasis.The biliary tract diseases were diagnosed based on medical history, clinical symptoms and signs, and imaging findings using ultrasonography, computed tomography, or magnetic resonance cholangiopancreatography.Results The PAD group contained a significantly larger number of patients with biliary stones including stones in the primary common bile duct, SOD with bile duct stones (p < 0.05), and choledocholithiasis after cholecystectomy (p < 0.01).Conclusions There is a close correlation between PAD and the formation of biliary tract stones.A particularly close correlation was found between PAD and choledocholithiasis after cholecystectomy.PAD may be an important risk factor for the occurrence or recurrence of biliary tract stones.