This 54 year old gentleman had obstructive jaundice due to a metastatic cholangiocarcinoma and was due to undergo placement of a self expanding metallic stent. Going in, we were welcomed by a worm at the junction of bulb and descending duodenum (A: white arrow). Contrast injection showed a sharp cutoff above the mid CBD (B: white arrow). The guidewire was placed across the strictured segment after some maneuvering and contrast injection showed the extent of the stricture (C: white arrows) and dilated intrahepatic ducts. The stent assembly was then positioned across the tumor area (D: white arrows). A 10 mm wide 10 cm long uncovered self expanding metallic stent was deployed (E: white arrows).
