Interesting rendezvous location in a liver transplantation patient with anastomosis stricture

Abstract

An endoscopic or radiologic percutaneous approach may be an initial minimally invasive method for treating biliary strictures after living donor liver transplantation; however, cannulation of biliary strictures is sometimes difficult due to the presence of a sharp or twisted angle within the stricture or a complete stricture. When an angulated or twisted biliary stricture interrupts passage of a guidewire over the stricture, it is difficult to replace the percutaneous biliary drainage catheter with inside stents by endoscopic retrograde cholangiopancreatography. The rendezvous technique can be used to overcome this difficulty. In addition to the classical rendezvous method, in cases with complete transection of the common bile duct a modified technique involving the insertion of a snare into the subhepatic space has been successfully performed. Herein, we report a modified rendezvous technique in the duodenal bulb as an extraordinary location for a patient with duct-to-duct anastomotic complete stricture after liver transplantation.

Keywords: Liver transplantation, Anastomosis stricture, Endoscopic radiologic rendezvous, Duodenal bulb

Core tip: An endoscopic-radiologic rendezvous technique may be used for stent application in the treatment of biliary strictures where previous endoscopic retrograde cholangiopancreatography and percutaneous transhepatic attempts have failed. Recently, it was reported that successful endoscopic-radiologic rendezvous procedures were performed in the subhepatic space in patients with complete transections of the common bile duct, especially secondary to surgical injury. Herein, we report a modified rendezvous technique in the duodenal bulb as an extraordinary location in a patient with a duct-to-duct complete anastomotic stricture after liver transplantation.