An 80 year-old man with prior left hepatic lobectomy for hepatocellular carcinoma presented with cholangitis due to biliary stent occlusion. CT scan showed biliary dilation and duodenal stenosis due to progression of a known ampullary adenocarcinoma. ERCP was unfeasible. After placement of an orojejunal tube and distension of the jejunal loop, EUS-GE was created using a 20mm LAMS. Due to the left hepatectomy, a standard transgastric opserative window for EUS-HGS was not found. Hence, a more prepyloric access was selected to access a mildly dilated right intrahepatic biliary tree. EUS-HGS was completed deploying a 10×80 mm partially covered metal stent. HGS access was further used to extract stones from the common bile duct (CBD) and to promote antegrade SEMS-in-SEMS stenting. The patient recovered uneventfully, and no further cholangitis occurred during a 3-month follow up.