“…There is, however, a small subset of patients for whom transpapillary stent placement is not possible due to tumor infiltration/obstruction of the duodenum or failed biliary cannulation as a result of previous surgery, a periampullary diverticula, or convoluted bile duct [5][6][7]. In such cases, percutaneous transhepatic cholangiography and drainage (PTC)-internal or external-is an alternative means to avoid surgery [8][9][10]. Nonetheless, PTC can lead to significant complications, including biliary peritonitis, perforation of the gallbladder, hemobilia, pneumothorax, and a discomfort caused by catheter placement [11].…”