IR-driven percutaneous cholangioscopy with SpyGlass-assisted lithotripsy is an emerging salvage technique for biliary stone disease in patients with failed or contraindicated endoscopic retrograde cholangiopancreatography (ERCP) due to complex anatomy. We report an 85-year-old patient with an indwelling cholecystostomy tube and biliary stent who presented with recurrent obstructive jaundice, with cholangiography demonstrating occlusion of the common bile duct stent due to choledocholithiasis. Conventional ERCP was unsuccessful because of complex biliary and gastrointestinal anatomy. A multidisciplinary interventional radiology–gastroenterology approach was therefore pursued, utilizing antegrade percutaneous choledochoscopy through an existing cholecystostomy tract with SpyGlass-assisted lithotripsy, followed by cholecystostomy tube exchange. The procedure resulted in successful ductal clearance, no major periprocedural complications, and complete resolution of symptoms. This case highlights the safety and feasibility of SpyGlass-assisted lithotripsy via a cholecystostomy access route as a minimally invasive salvage strategy and underscores the importance of multidisciplinary collaboration in the management of complex biliary stone disease.

Analytical, Diagnostic and Therapeutic Techniques and Equipment
Digestive System Diseases
Diseases
Gastroenterology
Internal Medicine
Medical Specialties
Medicine and Health Sciences
Surgical Procedures, Operative