Upper gastrointestinal bleeding (UGB) is a frequent and potentially life-threatening condition that is managed in most cases with endoscopic therapy ¹. Endovascular therapy (ET) or, rarely, surgical therapy are generally required in case of uncontrolled or refractory bleeding ². We present the case of a 77-year-old woman who presented to the emergency department (ED) for melena. Due to hemodynamic instability and the evidence of gastroduodenal pseudoaneurysm with active duodenal bleeding at urgent TC, a direct ET was performed. After 5 days, the patient presented jaundice and inflammatory markers’ elevation (total/direct bilirubin 5/3.2, GGT 350, ALP 430, WBC 15.2, PCR 14.5). Cross-sectional imaging revealed pancreatic necrosis with edematous thickening of the duodenal wall, but without clear evidence of biliary obstruction. Endoscopic ultrasound (EUS) was therefore performed, which showed a slightly dilated common bile duct (CBD) with caliber reduction in the pre-papillary tract due to a hypoechoic mass determining the loss of duodenal wall stratification, compatible with pancreatic tissue and pseudoaneurysm necrosis. Hyperechoic non-projecting material inside the CBD and gallbladder, and slight dilation of the intrahepatic biliary ducts were also observed.  On EUS basis, an endoscopic retrograde cholangiopancreatography (ERCP) was performed. During ERCP, the descending duodenum mucosa appeared covered by fibrinous-necrotic material mixed with biliary material. Vater papilla was markedly fragile and surrounded by necrotic tissue. CBD was selectively cannulated, and a fully covered biliary metal stent 10 mm x 40 mm was placed, with prompt outflow of purulent bile and an hourglass appearance of the stent, due to compression exerted by the pseudoaneurysm and pancreatic necrotic tissue. After ERCP, the patient progressively recovered from jaundice and presented a few episodes of melena, managed with medical therapy until Hb values became stable. The patient was initially maintained fastened with a nasogastric tube (NGT), and progressively fed with enteral nutrition and then with oral diet. After 1 month, an esophagogastroduodenoscopy was performed, showing normal duodenal mucosa with the biliary stent through the papilla. A TC was performed after 6 months, which showed a reduction of the necrotic area with well-positioned biliary stent and aerobilia. An ERCP for stent removal is scheduled within 1 month. This case shows how endoscopy may be necessary and resolutive in UGB, not only as a first-line treatment, but also in the event of complications arising from other therapeutic strategies. Endoscopists should thus be ready to promptly and transversely intervene.