Abstract: This article reported a case of a 69-year-old male patient admitted the hospital due to acute abdominal pain accompanied by fever. The patient was diagnosed with choledocholithiasis complicated by cholecystolithiasis through a combined examination of CT and magnetic resonance cholangiopancreatography (MRCP). Given the severe systemic inflammatory response in the patient, a cholecystostomy was initially performed to alleviate the inflammation, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone removal. During the procedure, a stone with a diameter of approximately 8 mm was found to have migrated from the common bile duct to the cystic duct. Innovatively, direct-vision electronic cholangioscopy (DSOC) was employed for treatment, and the stone was successfully extracted by combining negative-pressure suction in the cystic duct with guidewire traction techniques. After the operation, the patient's abdominal pain was significantly relieved. Five months after discharge, the patient underwent cholecystectomy without any recurrence during this period. This case provided new insights into theminimally invasive treatment of complex biliary stones and suggested that the combination of DSOC and negative-pressure suction techniques may help reduce the risk of stone recurrence.