A 34-year-old female with a history of advanced pulmonary sarcoidosis and right-sided heart failure presented with chronic, postprandial right upper quadrant pain, and weight loss. Endoscopic biliary drainage was deemed to be the most appropriate therapeutic option for her chronic cholecystitis. Endoscopic retrograde cholangiopancreatography utilizing the SpyGlass cholangioscopy system allowed us to access the cystic duct through which the gallbladder was ultimately decompressed, via biliary stent placement and gallstone irrigation. This is the fi rst report of SpyScope assisted placement of fully covered self-expandable metal biliary stents into the cystic duct enabling defi nitive treatment of symptomatic chronic cholecystitis and cholelithiasis without cholecystectomy. (Gut Liver 2012;6:136-138)