This 85 year old gentleman had obstructive jaundice due to a locally infiltrative, metastatic gallbladder tumor. This case was difficult from the word go. We had to dilate the pharyngo-esophageal area with a 45 French dilator as the ERCP scope wouldn't go across. We saw extensive esophageal candidiasis. Maneuvering the scope across the pylorus was extremely difficult as well. However, once in, cannulation was achieved swiftly. Contrast injection showed a long stricture due to the tumor (A: white arrows). After placing a stent assembly across the strictured segment (B: white arrows), a self expanding metallic stent of 10mm diameter and 80mm length was deployed (C1 & C2: white arrows).
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