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A 62-year-old woman presented with marked cholestasis (bilirubin 9.8mg/dL), and ultrasound suggested intrahepatic biliary dilation down to the hilum and a solid-filled gallbladder. Claustrophobia precluded magnetic resonance imaging, but computed tomography imaging excluded distant metastases. Endoscopic ultrasound suggested an anomalous pancreaticobiliary junction (APBJ) with extramural pancreaticobiliary confluence, a solid gallbladder mass, and an independent, vague 12mm hypoechoic hilar lesion, thus suggesting double carcinoma formation in the biliary tract [1, 2]. Endoscopic retrograde cholangiopancreatography (ERCP), under antibiotic coverage with oral levofloxacin for 3 days, revealed a long common channel of 12mm with associated APBJ. Of note, the pancreaticobiliary ductal junction remained functionally uninterrupted during sphincter contraction, thus favoring true pancreaticobiliary maljunction (PBM) without biliary dilation over high confluence of pancreaticobiliary ducts (HCPBD) (▶Fig. 1). E-Videos

West meets East: dynamic ERCP characterization of pancreaticobiliary maljunction without biliary dilation underlying extensive biliary tract cancer