This 24 year old gentleman was undergoing his fourth ERCP this patient was undergoing for his anastomotic stricture. No stent was placed at his last visit http://ercp365.blogspot.com/2014/03/third-follow-up-ercp-for-post.html but this time around he was developing fever and slight rise in his bilirubin levels. His ampulla showed adequate outflow of bile (A: Black arrow). Initially our guidewire passed only up to just below the anastomotic site and contrast outlined a normal calibre lower CBD (B: Black arrows indicate the native bile duct). Finally our guidewire crossed the stricture site and the graft ducts were also outlined (C: White arrows show the stricture. Blue arrow shows the guidewire which isn't yet going straight up as we would like. Red arrow shows the dilated ducts in the graft). With repeated efforts we were able to get the wire go up in a direct line (D: Black arrows show the native bile duct, of normal calibre. White arrows show the structured anastomotic site. Blue arrow shows the tip of the guidewire). We dilated the stricture with a 10 French graduated dilatation catheter (E: White arrows mark the catheter). A stent assembly was then placed across the stricture and a 10 French plastic stent of 12 cm length ( F: White arrows show the stent assembly and black arrows indicate the stent passing over the assembly) was passed (G: Black arrows mark the deployed stent).
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