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To assess the value of ultrasound, if indicated, supplemented by sialendoscopy, in the diagnosis of sialolithiasis.Retrospective study.Referring center for salivary gland diseases.All patients who presented with a suspected diagnosis of obstructive sialopathy between January 2011 and April 2017 and had not undergone any treatment were retrospectively evaluated. A total of 2052 patients and 2277 glands were included in the study. Ultrasound examinations were carried out initially and followed by sialendoscopy in all cases. Direct demonstration of sialothiasis by sialendoscopy, transoral ductal surgery, and discharge of concrements/observation of fragments during sialendoscopy after extracorporeal shock-wave lithotripsy were regarded as definitive evidence of sialolithiasis.Ultrasound had an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.77%, 94.91%, 94.57%, 96.14%, and 92.89%, respectively, for the diagnosis of sialolithiasis. All false-positive findings were correctly diagnosed, and in all false-negative findings, stones/fragments were visualized by sialendoscopy. Over 95% of the false-negative findings in major salivary glands (64/67) had visible ductal dilation in sonography, and in 73.1%, the stones not detected on ultrasound were located in the distal part of the duct, which is easily accessible with the sialendoscope.This study shows that sialolithiasis can be diagnosed using ultrasonography with a high degree of certainty. If supplemented by sialendoscopy, the correct diagnosis could be established in virtually all cases of sialolithiasis. Ultrasound supplemented by sialendoscopy has the potential to serve as an alternative diagnostic standard in the future.