A 41 years young lady who is a K/C/O Retro positive on ART. Patient had developed obstructive jaundice secondary to CBD stone 4 years back. For which she underwent ERCP & CBD stenting at Pune. Due to large size of stone, stone could not be removed. Hence only CBD stenting was done. Now this patient came to us with H/o intermittent fever with chills with obstructive jaundice since 4 months. CBD stent was not removed.

At Antrang Hospital she underwent ERCP, which showed 10 french blocked stent, which was removed. Multiple large stones were noted in entire CBD. Which could not be extracted by normal ERCP scope. So at this time we had 2 options 1) Surgical CBD exploration followed by Cholecystectomy, 2) Spy cholangioscopy.

So she underwent spy cholangioscopy during the same admission & stones fragmented by Laser lithotripsy & CBD was cleared with dormie basket & balloon sweepings & 10 french stent placed into the CBD. She was started on soft diet after six hours & got discharged within 48 hours.

1. Spycholangioscopy can be done through the same ERCP scope through working channel.
2. Stone can be directive visualized & lithotripsy can be done under vision. So that we can insure proper clearance.
3. It can be under minimal sedation without surgery & patient can be resume his daily activities & diet after 12 hours.