Introduction: Gallstone-associated cholecystitis and acute pancreatitis were reported to develop more frequently in summer and spring, respectively. However, there have been no reports confirming the association between meteorological factors and stone-associated pancreatohepatobiliary disease (SAPHBD), which includes acute cholelithiasis, acute cholecystitis, acute cholangitis, and acute pancreatitis. The aim of this study was to assess meteorological risk factors for developing SAPHBD. Methods: Retrospective longitudinal study was performed in a tertiary referral center in Tokyo, Japan from January 1 2012 to December 31 2013. In all SAPHBD patients, stones were confirmed by ERCP and/or percutaneous transhepatic biliary drainage (PTBD). Patients with neoplastic lesions or unclear onsets, were excluded. We collected daily meteorological data of Tokyo from the Japan Meteorological Agency calculating daily change of temperature, relative humidity, and barometric pressure. Bivariate analyses were performed through Spearman's correlation coefficient (SCC). Multivariate analysis was conducted by Poisson regression for calculating adjusted incidence rate ratio (IRR). Results: 437 patients underwent ERCP and/or PTBD, and 141 were diagnosed with SAPHBD [cholelithiasis (17%), cholecystitis (12%), cholangititis (61%), pancreatitis (10%)]. The mean age (SD) was 71 (14) years-old and 88 (62%) was male. Mean (SD) of temperature [celsius], humididy [%], and barometric pressure [hPa] was 17 (8), 62 (16), and 1008 (7), respectively. Mean (SD) daily change of temperature [celsius], humididy [%], and barometric pressure [hPa] was 7 (2), 32 (12), and 7 (5), respectively. SCC of daily change of temperature, humidity, and barometric pressure was 0.037, 0.011, and 0.089, respectively. Adjusted IRR [95%CI] of temperature, humidity, and barometric pressure using multiple Poisson regression was 0.98 [0.96, 1.0], 1.0 [0.997, 1.02], and 0.99 [0.96, 1.01]. Adjusted IRR [95%CI] of daily change of temperature, humidity, and barometric pressure was 1.06 [0.98, 1.1], 0.99 [0.98, 1.01], and 1.06 [1.03, 1.09], respectively. Conclusion: Daily change of barometric pressure is significantly associated with SAPHBD development. Lower temperature is also marginally associated with SAPHBD. These association can be applied for constructing local medical emergency system.