North Texas Research Forum 2026

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Division

North Texas

Hospital

Medical City Fort Worth

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2026

Keywords

percutaneous cholangioscopy, laser lithotripsy, endoscopic retrograde cholangiopancreatography, ERCP

Disciplines

Digestive System Diseases | Gastroenterology | Internal Medicine | Medicine and Health Sciences | Surgical Procedures, Operative

Abstract

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.

Original Publisher

HCA Healthcare Graduate Medical Education

Salvage Percutaneous SpyGlass-Assisted Lithotripsy via a Cholecystostomy Tract After Failed ERCP: A Case Report

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