Bile leaks and strictures are the main biliary complications diagnosed by endoscopic
retrograde cholangiopancreatography (ERCP) in living donor living transplantation
(LDLT) patients. Endoscopic management is difficult mainly because of the complexity
of duct-to-duct reconstruction. Recently, we have experienced five right-lobe LDLT
cases with cholangitis in which ERCP revealed S-shaped anastomotic stricture ([Figure 1 a]). The S-shaped stricture could not be passed with a guide wire, despite many maneuvers
and changing positions of the sphincterotome and standard balloon. However, it became
possible to pass the stricture with the guide wire by a novel method; the standard
balloon was inflated near the stricture in the distal part of the common bile duct
([Figure 1 b]). The inflated balloon was pulled slowly. After the common bile duct had become
slightly stretched, it was possible to pass the stricture with the guide wire ([Figure 1 c]). Thereafter, we were able to perform balloon dilation and plastic stent placement
in all cases ([Figure 1 d]). We believe that this novel technique is effective for S-shaped anastomotic strictures
that cannot be passed with a guide wire.
Figure 1 a S-shaped anastomotic stricture. b The inflated standard balloon near the stricture in the distal part of the common
bile duct. Thereafter, it was pulled slowly. c After the common bile duct had become slightly stretched, it was possible to pass
the stricture with the guide wire. d View following successful placement of a double plastic stent.
Endoscopy_UCTN_Code_TTT_1AR_2AG
