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Indeterminate biliary strictures represent a clinical challenge [1, 2]. Endoscopic retrograde cholangiopancreatography (ERCP) with brushings and transpapillary biopsies have limitations in terms of their sensitivity and specificity [3, 4]. Cholangioscopy plays a relevant role in this field with a high sensitivity for the macroscopic appearance [5]. A 60-year-old woman, who had undergone total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma (pT2 N0 M0) 4 years previously, presented to our ambulatory unit with upper abdominal pain and alteration of liver function tests. An abdominal computed tomography scan (▶Fig. 1) and magnetic resonance cholangiopancreatography (MRCP) (▶Fig. 2) showed bile duct dilatation and a distal stricture of the common bile duct. However, an endoscopic ultrasound (EUS) approach was not feasible or effective because of her altered anatomy. A first attempt to reach the papillary area and perform a subsequent ERCP using a pediatric colonoscope was unsuccessful owing to the length and angulations of the jejunal loop. Therefore, a hepaticojejunostomy was performed endoscopically (▶Fig. 3 a). First, a transjejunal heE-Videos

Indeterminate biliary stricture treated by antegrade cholangioscopy through an endoscopic ultrasound-guided hepaticojejunostomy