Malignant biliary obstruction is a sinister condition that require radical treatment in order to provide the hope of a cure. Apart from complex surgery, the major clinical challenge remains the difficulty in making a conclusive diagnosis (1). There is a long list of differential diagnosis for obstruction of the bile duct including benign condition like primary sclerosing cholangitis, iatrogenic injury, infection and IgG 4 related conditions to malignant condition like carcinoma involving the whole course of bile duct, pancreatic carcinoma and adenocarcinoma in the periampullary regions (2-5).