Effective remediation of heavy metal pollution in aquatic systems is desired in many regions, but it requires integrative assessments of sediments, water, and biota that can serve as robust biomonitors. We assessed the effects of a 5-year metal contamination remediation along the Xiangjiang River, China, by comparing concentrations of trace metals in water and surface sediments between 2010–2011 and 2016. We also explored the trace metal biomonitoring potential of a freshwater gastropod (Bellamya aeruginosa). Metal concentrations in water (means and ranges) dropped over time to within permissible limits of drinking water guidelines set by China, USEPA, and WHO in 2016. Although sediment means and ranges of Cd, Pb, Zn, and Mn also diminished with remediation, those for Cr and Cu slightly increased, and all six metals retained concentrations higher than standards set by China. All metals in sediments could also be associated with anthropogenic inputs using a hierarchical clustering analysis, and they generate high potential ecological risks based on several indices, especially for Cd and As. The bio-sediment accumulation factors of all measured trace metals in gastropod soft tissues and shells were lower than 1.0, except for Ca. Trace metal contents in gastropods were positively correlated with those in water and surface sediments for As (soft tissues) and Cr (shells). Collectively, our results do not yet highlight strong beneficial effects of 5-year remediation and clearly illustrate the heavy metal pollution remaining in Xiangjiang River sediment. Additional physical, chemical, and biological measurements should be implemented to improve sediment quality. We further conclude that gastropod soft tissues and shells can be suitable biomonitors of spatial differences in some heavy metals found within river sediments (e.g., As, Cr).