Case Series: Cholangioscopy-Guided percutaneous biliary stone extractiontext_resourcesPurpose To evaluate safety and efficacy of percutaneous biliary stone extraction using Spyglass DSTM cholangioscopy. Materials and Methods Eleven patients (mean age = 72.7 years, 5 females and 6 males) underwent cholangioscopy-guided percutaneous stone extraction between March 2023 and March 2024. All patients were evaluated by surgeons and gastroenterologists prior and deemed not candidates for surgical or endoscopic interventions. Nine patients had symptomatic cholelithiasis and two patients had symptomatic choledocholithiasis. All stone extraction procedures were performed with SpyglassTM DS system (Boston Scientific) under general anesthesia. Results The median post-procedural follow-up period was 214 days. Initial cholecystostomy access was transhepatic in 6 patients and transperitoneal in 5 patients. Median cholecystostomy tube indwelling time after stone removal was 19 days. One patient experienced cystic duct injury during the procedure, which resolved spontaneously (Grade 1). No other immediate complications were observed. Nine patients (82%) remained asymptomatic during the follow-up period; one (9%) experienced recurrent cholelithiasis and symptoms 7 months post-procedure, while another (9%) developed acute biliary obstruction 7 months after the procedure, spontaneously resolving, possibly due to choledocholithiasis or Lemmel Syndrome. Conclusion Early experience with cholangioscopy-assisted percutaneous biliary stone extraction suggest that it is a safe and effective option for managing biliary stones in high-risk, nonsurgical patients.Bae, MichelleAuthorAbraham, JacobAuthorAbdifatah, OmarAuthorYoon, JessicaAuthorMaxwell. AaronAuthorAhn, Sun HoAuthorKim, DaeheeAuthorBrown University. Alpert Medical School. Scholarly Concentration Program. Non-Scholarly Concentratorresearch programCholangioscopyPercutaneous cholecystostomyEnglish2024Non-Scholarly ConcentratorAll rights reservedIn CopyrightAll Rights Reserved