Combine Use of Peroral and Transhepatic Cholangioscopy Increases the Success Rate of Negotiation of Post Liver Transplant Anastomotic Stricture after Previously Failed Endoscopic and Interventional Radiology Procedures: First Case Report In Literature

Aims Background: Post liver transplant anastomotic strictures are now conventionally being manage non surgically using endoscopic approach or in case of failure by interventional radiology procedures. If both the approaches fail, then endo-biliary endoscopy can be used in the form of either transpapillary or transhepatic cholangioscopy. Here we are reporting combine use of both the technique.

Case Report A 47-year-old male s/p Living donor liver transplant on 25-10-21, single RHD anastomosis presented with obstructive jaundice confirmed with imaging. He underwent three ERCPs in which only RASD was stented, but RPSD never cannulated. PTBD of RPSD was performed and external drain placed but three attempts failed to internalized the drain due to failure to negotiate AS.

Description of technique: We intially approach the patient through transhepatic route but despite the identification of opening, negotiation could not be done due to complete occlusion and acute angle.

Next peroral cholangioscopy was performed and after much difficulty glide wire was finally negotiated. As the length of guide wire was short so it was retrieved transhepatically. Later it was exchanged with 480 cm 0.035 jagwire. The anastomotic stricture was dilated using 8 mm CRE balloon. A 10 Fr x 12 cm PBS placed. Another steny was than placed in RASD.

Conclusions Combine use of Transpapillary and transhepatic cholangioscopies increases the therapeutic options in the management of post-transplant anastomotic strictures.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023