Endoscopic management of biliary strictures post-liver transplantation

Figure 1 Evaluation of suspected bile duct strictures post-liver transplantation. LDT: Living donor transplantation; LT: Liver transplantation; RUQ: Right upper quadrant.

Figure 2 Anastomotic bile duct stricture managed with biliary stenting and balloon dilation. A: A patient less than 60 d post-liver transplantation who presented with elevated liver tests and found to have an anastomotic bile duct stricture; B: The patient was managed with serial balloon dilation and multiple biliary stents; C: Approximately 9 mo post-liver transplantation the anastomotic stricture had resolved and required no further intervention.

Figure 3 Anastomotic bile duct stricture treated with rendezvous technique. A: A 56-year-old patient who presented two years after transplantation with jaundice and found to have a severe anastomotic stricture which was not able to be traversed with a guidewire; B: Percutaneous transhepatic cholangiogram showing a stricture at the anastomosis with the guidewire inserted through the transhepatic tract; C: The rendezvous technique was used to advance the endoscopic catheter over the transhepatic guidewire and proximal to the anastomotic stricture; D: A fully covered metal biliary stent was placed traversing the anastomosis.