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An 82-year-old man with alcohol-related cirrhosis (Child-Pugh class B), complicated by portal hypertension and a history of partial gastrectomy with Billroth I reconstruction for duodenal ulcer disease, underwent surveillance upper gastrointestinal endoscopy (UGE). UGE revealed large oesophageal varices and a 20-mm exophytic, infiltrative, ulcerated lesion located 40 cm from the dental arch ( figure 1A). Histological evaluation of endoscopic biopsies was inconclusive. Endoscopic ultrasound demonstrated a heterogeneous, amorphous lesion with poorly defined margins and disruption of all layers of the oesophageal wall (figure 1B, C). Multiple large oesophageal varices posed a significant haemorrhagic risk, precluding further biopsy. Contrast-enhanced CT showed parietal thickening of the distal oesophagus associated with extensive varices, limiting accurate lesion characterisation.