Last month a patient with malignant obstruction of the high biliary tract in the hilar region was successfully relieved of jaundice by ERCP minimally invasive surgery. The patient, an elderly male, was admitted to the hospital with jaundice after gallbladder cancer surgery. Examination revealed that the gallbladder cancer had recurred after surgery and the bile ducts in the hilar region were invaded by the tumor, resulting in high biliary obstruction and severe obstructive jaundice and hepatic insufficiency, as well as combined with distant metastases throughout the body. The patient’s general condition was poor, with abdominal distension, massive ascites, scrotal edema of the lower limbs, liver function tests suggesting elevated bilirubin up to 500 μmol/l, significantly high transaminases, and hepatorenal syndrome with renal insufficiency. After several consultations, it was concluded that liver and kidney failure would rapidly occur without releasing the obstruction, which would threaten the patient’s life. Due to poor general condition, the patient could not tolerate traditional surgical treatment, and after analyzing the imaging data, it was decided to perform transendoscopic retrograde cholangiopancreatography (ERCP), bile duct obstruction dilation, and bile duct endoprosthesis. In order to reduce the risk, the operation was performed under local anesthesia. The intraoperative intubation angiography revealed that the biliary obstruction was located high in the hepatoportal area and the bile duct was almost completely closed due to tumor infiltration. The stenosed bile duct was supported and dilated under the imaging, and the bile flow was seen under the microscope. After the operation, the patient recovered well without complications such as pancreatitis, and the bilirubin dropped rapidly. 2 weeks after the operation, the bilirubin dropped to basically normal after the treatment of liver protection and biliary benefit, the edema of the lower limbs and scrotum disappeared, the ascites decreased significantly, the abdominal distension improved significantly, and the patient resumed normal feeding, and the patient’s liver and kidney function improved significantly with better tolerance, and was ready for further tumor-related treatment. Liu Wei, Minimally Invasive Surgery Department, Second Xiangya Hospital High malignant biliary obstruction refers to the compression or occlusion of the biliary tract in and around the hepatoportal area caused by malignant tumor, resulting in clinical manifestations such as obvious skin-sclera jaundice, liver insufficiency and even multi-organ failure. The management of high-grade malignant biliary obstruction is a difficult problem in clinical practice, as patients often have advanced disease and are not eligible for radical surgery but can only choose palliative internal or external drainage or percutaneous percutaneous hepatic biliary drainage (PTCD). For patients who cannot undergo radical resection or cannot tolerate surgery, stenting can achieve or even surpass the effect of palliative drainage surgery.