The first patient was an 87-year-old male who presented with a one-week history of obstructive jaundice. Abdominal CT showed an ampullary mass surrounding the pancreatic head with a large juxtapapillary diverticulum, as well as the dilation of the extra- and intra-hepatic bile duct. ERCP revealed intradiverticular papilla, bile flow into the diverticulum from the major papilla and a nodular lesion around the diverticulum, with the formation of a shallow ulcer. Cannulation of the major papilla through ERCP failed. However, a biopsy was obtained from the nodule lesion and a well-differentiated adenocarcinoma was confirmed by pathological analysis. The patient was of advanced age and refused surgery. PTBS was performed. The patient recovered well following the procedure and was discharged from the hospital three days after surgery.