 A 69-year-old man presented with obstructive jaundice due to recurrence 18 mo after distal gastrectomy and Roux-en-Y reconstruction for gastric cancer. A recurrent mass with central necrosis (white arrowheads) obstructed the extrahepatic bile duct (black arrow), causing dilatation of intrahepatic bile ducts and gallbladder (white arrows). While endoscopic ultrasound-guided hepaticogastrostomy led to symptomatic relief, the patient died 1 mo later.