Endoscopy 2019; 51(04): S228-S229
DOI: 10.1055/s-0039-1681854
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

BILE CAST SYNDROME- A RARE CAUSE OF BILIARY OBSTRUCTION AFTER LIVER TRANSPLANTATION SUCCESSFULLY MANAGED USING DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY

P Karagyozov
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
I Tishkov
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
I Boeva
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Aims:

We report a case of bile cast syndrome 6 months after orthotopic liver transplantation successfully diagnosed and treated using digital single-operator cholangioscopy.

Methods:

A 29-year old male patient was referred to our unit with jaundice and diffuse itching in the last 3 weeks, 6 months after deceased donor liver transplantation. Magnetic resonance cholangiopancreatography demonstrated intrahepatic bile duct dilation and stenosis at the level of the anastomosis. Endoscopic retrograde cholangiopancreatography was performed. Occlusion cholangiography revealed intact biliary anastomosis, irregular stenosis with a length of 25 mm ending close to the bifurcation. Cholangioscopy was carried out. The anastomosis was easy to pass through, bile casts were found in the donor bile duct adherent to the biliary wall, causing partial obstruction of the lumen. The bile casts were successfully cleaned with saline irrigation and multiple balloon sweeps. A 10 f 12 cm plastic stent was placed to secure the drainage.

Results:

Subsequently normalization of the liver function tests occurred and the patient experienced symptomatic improvement. One month later the plastic stent was removed. Follow up cholangioscopy demonstrated almost completely clean bile ducts. The patient remains asymptomatic 9 months after the procedure.

Conclusions:

Bile cast syndrome is a rear obstructive cholangiopathy occurring as a complication after liver transplantation. The diagnosis could be difficult, relying only on the traditional imaging modalities. The condition may mimic anastomotic or non-anastomotic biliary stricture leading to inappropriate treatment choice. Digital single-operator cholangioscopy may add useful diagnostic information to ERCP and could be superior to the traditional imaging and interventional modalities in the diagnosing and treating this rare condition.