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Background: Common bile duct stones (CBDs) are the most common cause of obstructive jaundice and cholangitis. This occurs in about 10% of patients with symptomatic gallstone. This study aimed to find non-invasive preoperative tests for predicting CBDs to select patients for preoperative endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC). Methods: We conducted a prospective preoperative study on 896 patients with symptomatic gall stones who underwent LC at Al Hada military Hospital, Taif, Saudi Arabia from April 2006 to April 2010. All patients were subjected to clinical, laboratory (LFT) and ultrasound (US) examination. Patients with normal LFTs and US were referred to LC. Patients with jaundice and US proven CBD abnormality (stones, dilatation >7mm or both) were referred for ERCP for diagnosis confirmation and stone removal, followed by LC. Patients with jaundice and normal US were referred to magnetic resonance cholangiopancreatography (MRCP). When MRCP detected CBDs, the patients were referred for ERCP for confirmation and stone extraction followed by LC. MRCP and ERCP negative cases were subjected to LC with Intraoperative cholangiography (IOC). Results: There were 707/896 patients(78.5%) who had LC without the need for preoperative ERCP or/and MRCP. 193/896 patients(21.5%) were diagnosed to have obstructive jaundice on clinical and laboratory bases. 102/193(52.8%) had normal bile ducts by US, the other 91(47.2%) had CBD abnormalities on US. CBDs were found in 23/91(25.3%), dilatated CBD in 28/91(30.8%), and 40/91(40.3%) had dilated CBD with stones. These 91 patients were referred to ERCP. Stones were extracted in 20/23(87%) who had CBDs, 24/28(85.7%) with dilated CBD and 38/40(95%) who had both. The 102 patients with normal CBD on US were referred to MRCP, 70/102(68.6%) were normal by MRCP and were subjected to LC with IOC. CBDs were detected in 2/70(2.9%). 32/102(31.4%) had stones by MRCP and referred to ERCP which detected CBDs in 25/32(78.2%). When CBD was abnormal, ERCP detected stones in 82/91 patients (90%) and when normal ERCP detected stones in 27/102 (26.5%). MRCP helped avoid un-necessary ERCP in 68/102(66.7%) with false negative results of 2/102(1.96%) and false positive results of 7/102(6.7%). Conclusion: We have documented a considerably higher incidence of obstructive jaundice in our area, one that makes this simple disease a community health issue. Also, with the small number of MRCP machines most hospitals have a long waiting time facility. Our aim was to find a simple pathway to get the cost-effective balance between MRCP and ERCP. Therefore, patients with obstructive jaundice and abnormal CBD on US are considered of high risk for CBDs and the use of MRCP is not justified. However, if any of the tests were normal MRCP is indicated to decrease the incidence of negative ERCP.