OBJECTIVE: Compare patients who underwent saline flushing after mesh basket lithotripsy with combined balloon removal of biliary stones after mesh basket lithotripsy was performed with the aim of evaluating the feasibility of saline flushing after mesh basket lithotripsy with mesh basket combined with balloon stone removal. METHODS: A total of 76 patients who underwent endoscopic retrograde cholangio-pancreatography (ERCP) for choledocholithiasis in Henan Provincial People""s Hospital from May 2021 to May 2023 were retrospectively analyzed, of which 30 cases underwent saline biliary flushing after stone extraction with mesh baskets ("saline group"), The maximum diameter of common bile duct stones (CBDS) and common bile duct (CBD) was measured by abdominal ultrasound, endoscopic ultrasound, CT or magnetic resonance cholangiopancreatography (MRCP). No significant negative image in the bile ducts on imaging at the end of stone extraction was defined as successful stone extraction, and the success rate of the procedure, the procedure time (min), the cost of the procedure , and the postoperative complications (whether or not it was combined with fever, cholangitis, and pancreatitis) were counted and analyzed. RESULTS: The success rate of stone extraction was 100% in both saline and balloon groups, and the mean operative time in saline group (23.2±10.6 minutes) was shorter than the mean operative time in balloon group (29.2±10.1 minutes) (P=0.004). The mean operative cost in the saline group (￥13,343.1±1370.2) was less than the mean operative cost in the balloon group (￥16,137.4±579.8) (P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative fever, cholangitis, and pancreatitis. CONCLUSION: Compared with mesh basket combined with balloon extraction, saline biliary flushing after mesh basket extraction can shorten the operation time and reduce the operation cost while maintaining the operation success rate.