Inclusion Criteria:

   1. Age 18-80

   2. Biliary disease such as large stones necessitating electrohydraulic lithotripsy;

   3. Biliary strictures needing tissue acquisition through cholangioscopic directed
   biopsies

   4. Pancreatic-biliary malignancies needing tissue acquisition through cholangioscopic
   directed biopsies

   5. Willing and able to comply with the study procedures and provide written informed
   consent to participate in the study.

Exclusion Criteria:

   1. Age <18, > 80

   2. Potentially vulnerable subjects including pregnant women, homeless people, employees
   and students.

   3. Patients who have a clear indication for pre-procedure antibiotics based on current
   ASGE guidelines

   4. Patients who had received antibiotics for any reason within the prior 7 days

   5. Patients who had evidence of systemic infection at time of the ERCP

   6. Patients in whom additional venous access for blood cultures cannot be established.

   7. Participation in another investigational study within the previous 90 days