This 80 year old lady had a metastatic ampullary tumor. We were greeted by an infiltrated ampulla (A: green arrow) lying at the edge of a diverticulum (A: white arrow). This made cannulation extremely tricky. Repeated attempts were rewarded with success. Cannulation showed a significantly dilated CBD (B: white arrow) with distal narrowing (B: red arrow). A stent assembly was placed (C: white arrow) followed by deployment of a 7 cm long self expanding metallic stent (Micro-Tech Nanjing) of 10mm diameter (D: white arrows. E: white arrow shows the distal end of the stent in the duodenum.
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