Portal biliopathy

Figure 6 Endoscopic retrograde cholangiogram and metallic biliary stenting in a patient with portal biliopathy. A: Long smooth stricture common bile duct (arrow) with upstream dilatation of intrahepatic ducts (curved arrow); B: A 12 Fr plastic stent (arrow) is placed across the stricture. Patient needed repeated stent replacement in the follow up and was considered for shunt surgery. Shunt surgery was not possible due unavailability of a shuntable portal vein; C: Self-expanding nitinol biliary stent (arrow) placed across the stricture. Patient stays asymptomatic over long-term follow up.