Abstract The timely diagnosis and treatment of biliary tract conditions during pregnancy are challenging. Familiarity with the anatomic and physiologic changes present in normal pregnancy is essential, as is the knowledge of relative risk of complications by trimester. Physicians should be aware that virtually all complications that occur in the management of these conditions are caused by delay in the detection of the disease process. Recent advances in minimally invasive therapy including laparoscopic surgery and therapeutic gastro-intestinal endoscopy have changed the traditional approach to biliary tract disease in pregnancy. We present a case report of a patient with acute gallstone pancreatitis during pregnancy managed endoscopically without the use of fluoroscopy.