Post written by Shyam Menon, MSc, MD, FRCP, from the Department of Liver Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom.

Post liver transplantation anastomotic strictures can be technically challenging to manage. We describe a patient who presented a few months after liver transplantation with progressively deteriorating liver function tests and an episode of cholangitis. MRCP confirmed an anastomotic stricture. Guidewire access across the stricture failed at ERCP as the wire kept bouncing off a very tight stricture. Spyglass cholangioscopy was subsequently used to visualize this pinhole stricture and facilitate guidewire access across it. Following dilatation of the stricture and stenting, there was normalization of the patient’s liver function tests.

This video illustrates the challenges associated with managing post transplant biliary strictures and demonstrates the utility of the newer cholangioscopic platforms. Cholangioscopy can help in the management of complex or difficult biliary strictures by facilitating a visual assessment of the stricture and targeting guidewire placement.

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