Follow up case of post transplant anastomotic stricture

This patient underwent an ERCP and plastic stent placement following development of an anastomotic stricture after living donor liver transplant. The first ERCP was done three months ago ( two months after transplant) and showed a stricture at the site of anastomosis (A: white arrow). It was dilated with a 7 French dilatation catheter (B: white arrow) followed by a stenting with a 10cm long 10 French plastic stent (C: white arrows). We reviewed the patient again and decided to remove the previously placed stent and see the status of the stricture with a cholangiogram. The old stent was visualized on ERCP (D: white arrows) which was removed. Repeat contrast injection showed narrowing at the anastomostic site (E & F: white arrows). The strictured area was dilated with 8mm x 3cm TTS balloon (G & H: white arrows). Contrast injection now showed successful stricturoplasty (I: white arrows). A 10 French 10cm plastic stent was placed across the anastomotic site (J: white arrows). A second stent assembly was then placed parallel to the first one (K: blue arrow) after which a second 10 French plastic stent of 10cm length was placed (L: white arrows show the two stents placed in parallel).