Background and aims: Malignant EHBO is a common condition seen by gastroenterologist. There is scant data from south Asia about demography, clinical, laboratory, imaging & endoscopy features of patients with malignant EHBO. Material and Methods: We retrospectively analyzed our two year data. Diagnosis was based on imaging with cytological confirmation. Statistics used was percentage, median and range for Parametric data Results: Median age of the patients was 58 years (range 24–85 years), 43% were females. Carcinoma head of pancreas (CAHOP) 120(40%), periampullary carcinoma (PAC) 80 (26.6%), Gallbladder carcinoma (GBC) diagnosed in 50(16.6%) patient ,Cholangio carcinoma (CCA) 50 (16.6%). Diabetes and gall stones were present (10 % & 76% in GBC,60% & 4.1% in CAHOP, 4.5 % & 22.5% in PAC, 10% & 8% in CCA). Presenting symptoms were cholestatic jaundice, pain right hypochondrium, fever followed by weight loss, anorexia, vomiting and debility. Palpable gallbladder lump was present in 64 % of GBC, 90% of CAHOP, 47.5% of PAC and 10% of CCA patients. Cholangitis was present in 50% GBC, 87.5% CAHOP, 48.75% PAC and 72% of CCA patients. Imaging revealed liver infiltration in 66% in CGB , 7.5% of CAHOP & 6.25% PAC and 12% CCA patients Conclusions: CAHOP (40%) is most common cause of malignant EHBO in South India. Most patients of malignant EHBO except PAC presents in advanced stage. Palpable gallbladder present in nearly 60 % of cases, while cholangitis present in two third of the patients.