This gentleman had come after about four months after his last ERCP http://www.ercp365.blogspot.com/2015/02/fourth-follow-up-ercp-for-post-lover.html?m=1. We had placed a single plastic stent at that time. His labs showed a normal bilirubin but constantly rising ALP and GGT. His ultrasound showed no pneumobilia with the proximal tip of the stent slightly distal to the anastomotic site. We removed his stent and manoeuvred the guidewire across the stricture (A: Black arrow shows the guidewire curling back across the site of the stricture. B: The wire finally across the strictured segment, indicated by the black arrow. Contrast injection shows dilated ducts in the implanted liver indicated by white arrows) . A pneumatic balloon rated to 8 atm/10 mm was used. It was placed across the stricture (D: black arrows show the balloon assembly and blue arrows show its proximal and distal radio opaque markers). The balloon was then inflated (E: black arrows mark the fully inflated balloon with an obliterated "waist"). Repeat contrast injection showed a fully dilated stricture (F: blue arrows). No stent was placed this time and the patient was discharged. We expect to see him in the OPD with a fresh ultrasound and LFTs in a few weeks.
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