The physiological changes of pregnancy increase the risk of gallstone formation, and choledocholithiaisis is the most common indication for endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy. ERCP has been performed during pregnancy for over 20 years. Despite the apparent efficacy and lack of adverse fetal outcomes in published case series and reports, there remains a concern for the use of fluoroscopy during pregnancy. Recent focus has centered around avoidance of the use of fluoroscopy during ERCP, including the use of alternative techniques to confirm biliary cannulation and ductal clearance. The benefits of these techniques over traditional ERCP technique are unclear. In this article, we will review the epidemiology of gallstone disease during pregnancy, outline the risks of ERCP during pregnancy, and describe recent novel techniques in endoscopic biliary intervention for biliary drainage and ductal clearance.