A 27-year-old female with a history of cholecystectomy for symptomatic cholelithiasis three years prior to admission presented with epigastric pain radiating to the right upper quadrant and back. Initial laboratory tests on presentation were a total bilirubin (TBili) 5.5 mg/dL, alkaline phosphatase (ALP) 288 U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4). Following failed attempts at balloon-assisted stone extraction, cholangioscopy was performed. A single therapeutic endoscopist who has performed >30 interventions using the SpyGlass system was the primary operator and the case was performed under general anesthesia. A Pentax ED-3490TK therapeutic duodenoscope (Pentax Medical; Tokyo, Japan) was used to facilitate passage of the SpyGlass system. The 10 Fr SpyGlass cholangioscope measuring 250 cm in length was then used to directly visualize the stone in the cystic duct (Figure 5). The visualized stone was irrigated using saline prior to EHL, which was achieved using a Nortech Autolith system (Northgate Technologies Inc.; Elgin, IL) and a 1.9 Fr EHL probe. Power was set to 90 W with a rate of 3 pulsations/second, the latter of which was escalated as needed to achieve stone fragmentation. Subsequent balloon sweeps of the cystic duct successfully cleared stone fragments (Figure 6) and repeat MRCP (Figure 7) one year after hospital discharge revealed no evidence of fluid collection or stone in the cystic duct.