Patient description: The patient is a 41-year-old obese woman coming to the emergency room with abdominal pain and vomiting. The pain that started gradually yesterday is located in the epigastric and periumbilical regions, radiating to her back. She drinks alcohol frequently and does not smoke. She has no history of allergies and uses only multivitamins daily. Her family history is positive for hypertension (her mother). She lives with her husband and has 3 children. The abdomen is tender and soft. Her bowel sounds are normal. Her heart rate is 115/min and blood pressure 110/75 mmHg. The lab studies are remarkable for leukocytosis (19.5), urea of 8.5, high CRP (145), high amylase (1200) and Glucose level of 15. Her abdominal CT scan revealed acute edematous interstitial pancreatitis with enlarged common bile duct and intrahepatic duct confirming gall stone pancreatitis. Her pregnancy test is negative and she is not breastfeeding.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Biliary Stones 18 years or older 2. Abdominal pain consistent with choledocholithiasis (procedure possible within 72 hours of onset of symptoms and imaging suggesting choledocholithiasis, contingent on persistent abdominal pain) 3. Abnormal LFTs 4. Non-complex biliary stone disease, defined as 5 or fewer stones in the common bile or common hepatic duct with largest stone no larger than 10 mm in size. If stones not seen on imaging (US, CT) the bile duct diameter should be ≤12 mm* * Given the poor sensitivity (approximately 20%) for biliary stones of CT and US, the diameter of the dilated CBD is used as a surrogate for largest stone diameter 5. Availability of non-invasive imaging to determine the diameter of the bile duct and number and size of bile duct stones if visible on imaging 1. If probability of stones is high per investigator assessment based on ASGE any standard of practice imaging modality (eg. abdominal US) is acceptable. 2. If the probability of stones is either intermediate or low per investigator assessment based on ASGE MRCP or EUS imaging is required to confirm presence of stones. 6. Willing and able to comply with the study procedures and provide written informed consent to participate in the study  Potentially vulnerable subjects, including but not limited to pregnant women and subjects in whom an endoscopic procedure is contraindicated 2. Location of the stones in intrahepatic ducts, cystic duct or proximal to strictures 3. Bile duct stricture noted distal to stone on MRCP, which would make extraction without lithotripsy impossible 4. Ongoing cholangitis at time of randomization, manifested by fever with tachycardia and hypotension or evidence of pus at the ampulla 5. Patients with prior biliary sphincterotomy 6. Patients with Primary Sclerosing Cholangitis (PSC) 7. Acute pancreatitis, defined as abdominal pain and serum concentration of pancreatic enzymes [lipase (required), amylase (optional)] three or more times the upper limit of normal 8. Surgically altered gastro-duodenal luminal anatomy other than prior Billroth I reconstruction, as these would be anticipated to lead to more complicated procedures 9. Coagulopathy or ongoing need for anti-coagulation