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We are presenting a case of oral cancer with choledocholithiasis that was successfully treated with transgastric endoscopic retrograde cholangiopancreatography (ERCP). A 76-year-old female with past medical history of squamous cell cancer of the oral cavity status post hemiglossectomy with left anterolateral free flap, bilateral neck dissections, tracheostomy, and decannulation with gastrostomy tube placement, chemotherapy and radiation therapy presented with epigastric pain for 5 days. She experienced pain was radiating to the right upper quadrant and right flank, which was associated with nausea. Her vital signs were stable. Abdominal examination showed positive Murphy’s sign; 18-French (Fr) gastrostomy tube was present in left upper quadrant.

A tough scope to swallow: endoscopic retrograde cholangiopancreatography through percutaneous endoscopic gastrostomy