Post written by Pankaj Singh, DM Gastroenterology, Vikas Singla, DM Gastroenterology, and Akash Goel, DNB Gastroenterology, from the Centre of Gastroenterology, Hepatology and Endoscopy, Max Super Specialty Hospital, New Delhi, India.

Postliver transplant anastomotic site strictures are one of the common adverse events following liver transplants.

It is imperative to achieve adequate biliary drainage in such cases to preserve graft function. ERCP and percutaneous transhepatic biliary drainage are commonly used modalities to meet this goal.

In our case, the patient underwent percutaneous transhepatic biliary drainage, and internalization was attempted but failed on multiple occasions.

Antegrade cholangioscopy-guided wire negotiation failed as well. We describe a percutaneous cholangioscopy-assisted rendezvous ERCP technique for such difficult cases. 

In difficult cases of postliver transplant biliary strictures, this technique can help preserve graft function by establishing adequate biliary drainage and help avoid a major surgery of hepaticojejunostomy in cases unamenable to conventional ERCP.

A, The wire passed from pinhole size opening in right posterior sectoral duct to common bile duct. B, The guidewire coming out through ampulla into the duodenum.

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