Purpose: Choledocholithiasis, or common bile duct stones, can cause severe complications such as cholangitis, pancreatitis, and jaundice if untreated. While ERCP is the standard therapeutic approach, its safety and efficacy in surgically high-risk patients remain unclear. This study evaluates the long-term outcomes of ERCP as definitive management for choledocholithiasis in patients unfit for cholecystectomy. Methodology: This single-center retrospective study reviewed ERCP procedures performed at Townsville University Hospital from 2015 to 2018. Patients with confirmed choledocholithiasis and an ASA score ≥3 were included. Outcomes were assessed through chart reviews and follow-up calls to identify complications or hospital readmissions related to biliary disease. Results: Out of 243 ERCPs, 44 patients had confirmed choledocholithiasis. Nineteen patients did not undergo subsequent cholecystectomy; 15 of these were deemed unfit for surgery due to age, comorbidities, or functional status. During follow-up, no biliary-related hospital readmissions were recorded among these patients. Two deaths were reported: one intra-operative and one post-operative. The remaining patients experienced no recurrence or complications related to biliary disease. Conclusion: ERCP appears to be a safe and effective definitive treatment for choledocholithiasis in surgically high-risk patients, with minimal recurrence or complications. Larger multi-centre studies with extended follow-up are needed to confirm these findings and guide clinical management.