This 37 year old hospital nurse had undergone living donor liver transplant for Hepatitis C related liver disease. She had developed an anastomotic biliary stricture for which we had done two ERCPs previously, one in September http://ercp365.blogspot.com/2013/09/post-liver-transplant-anastomotic_10.html (single 12 French plastic stent passed) and second in December (Two 10 French plastic stents placed). The latest ultrasound suggested blocked stents. This was confirmed visually (A). Both the stents were removed with snare (B). Contrast injection showed the narrowing in the anastomotic site (C: white arrow). We decided to use a 3cm long, 10mm diameter TTS balloon rated at 90 psi (D) for stricturoplasty. The balloon was inflated in the stricture area (E1 to E3: white arrows). We then swept the CBD with a balloon to clear any sludge. An occlusion cholangiogram showed successful treatment of the stricture (F: white arrow). Although we were thinking pre procedure of placing three stents, the stricturoplasty results made us decide against it. No stents were placed and the patient will now be followed with serial bilirubin levels and ultrasound scans.
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