Malignant jaundice with duodenal obstruction can prevent conventional transpapillary biliary access. EUS-HGS may be considered for jaundice palliation. A 54-year-old patient with locally advanced pancreatic head adenocarcinoma, previously treated with a biliary stent and gastroenterostomy for duodenal bulb stenosis, re-presented after one month with jaundice. CT showed left intrahepatic biliary dilatation. EUS-HGS was attempted but failed due to an inadequate EUS window. Duodenoscope passage across the stricture was not feasible. A therapeutic gastroscope (3.2-mm channel) reached the papilla, where the prior stent was obstructed by tumoral ingrowth. With duodenal retroversion, the main bile duct was achieved and a new metal stent was placed. Control fluoroscopy showed marked bilateral aerobilia.