This 24 year old patient underwent a living donor liver transplant in June. He developed an anastomotic biliary stricture post surgery, as was evident on the MRCP (A: white arrow). We placed a 10 French plastic biliary stent of 12 cm length in early October (B: white arrows). A repeat follow up ERCP was now done in which the previous stent was removed. Repeat contrast injection showed two strictures, one at the anastomotic site and another higher up involving the right anterior duct (C: white arrows). It was decided to do a balloon stricturoplasty using a TTS balloon of 10mm diameter and 3 cm length. First the lower stricture was dilated (D1: white arrow indicating the balloon waist at the stricture. D2: Fully inflated balloon, with obliteration of waist). This was followed by similar dilatation of the right anterior duct stricture (E: white arrow). We passed two stents, both of 10 French diameter. The first was 12cm long, intended to traverse both the strictures (F1: white arrows). The second was 10cm long and reached just beyond the lower, anastomotic stricture (F2: white arrows).
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