A 72-year-old man with a malignant hilar biliary obstruction was referred to our endoscopy unit for biliary drainage. The patient had undergone esogastrectomy for an esophagogastric junction adenocarcinoma in 2011, fol- lowed by total gastrectomy with colon interposition in 2019 for a gastric adenocarcinoma. There was an esopha- gocolonic anastomosis and a side-to-side duodenocolonic anastomosis. The patient was referred for biliary obstruc- tion due to perihilar carcinomatosis with no sign of chol- angitis but with dysphagia related to an upper anastomosis stenosis.
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