Extrahepatic biliary obstruction by gallstones during pregnancy is a difficult management problem. We present five patients--four with acute cholangitis and one with gallstone pancreatitis--in whom a surgical procedure was avoided by endoscopic sphincterotomy. All five women delivered healthy babies at term. Endoscopic retrograde cholangiopancreatography and sphincterotomy can be performed safely in pregnancy with minimal exposure to radiation. Endoscopic management should be considered in women presenting with acute cholangitis or gallstone pancreatitis during pregnancy.