The second case was that of a patient with a surgical history of cholecystectomy and subtotal gastrectomy with Billroth II anastamosis, who presented with symptomatic CBDS. ERCP failed to access the ampulla despite facilitation with a rendezvous procedure. The patient underwent percutaneous transhepatic cholangiography (PTC), and the surgeon performed choledochoscopy via the liver tract to successfully extract the CBDS.