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). 

Achalasia or pseudoachalasia?

This 45 year old patient had been referred from another institution for balloon dilatation for achalasia of cardia. He had undergone an upper GI endoscopy and nothing unusual had been discovered. A barium swallow showed the classic bird beak lower esophagus (A: green arrow). The manometric findings also suggested classic achalasia. When we went in to dilate and retroflexed to view the fundus prior to wire insertion, the esophago-gastric junction was seen to be ulcerated and indurated (B:green arrow). We took biopsies (C: green arrow) and cancelled the dilatation till the biopsy report and a CT scan of the lower chest and abdomen.

Balloon dilatation for achalasia of cardia

Achalasia of the cardia. We used a Rigiflex balloon to dilate it. The first image (A) shows the waist of the balloon at the lower esophageal sphincter. The second image shows obliteration of the waist after balloon dilatation (B). Following dilatation the standard protocol barium swallow showed no leakage of contrast material (C). Dotted green arrows showing the areas of interest.