Management of liver transplantation biliary stricture: Results from a tertiary hospital

Figure 1 Algorithm for evaluation of suspected biliary obstruction after orthotopic liver transplantation in patients with duct-to-duct reconstruction. MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatographys.

Figure 2 Flow chart of patients in the study. ERCP: Endoscopic retrograde cholangiopancreatographys; SEMS: Stent-expandable metal stents.

Figure 3 Patient with post-orthotopic liver transplantation anastomotic stricture from index endoscopic retrograde cholangiopancreatographys. A: Retrograde cholangiogram demonstrating post-OLT anastomotic stricture (arrow); B: Patient was treated with progressive multiple plastic stents; C: Patient was treated with progressive multiple plastic stents; D: Final cholangiogram revealing complete stricture resolution. OLT: Orthotopic liver transplantation.

Figure 4 Patient with post-orthotopic liver transplantation anastomotic stricture. A: Post-OLT anastomotic biliary stricture; B: Placement of a fully covered SEMS across the stricture as a primary therapy option; C: Endoscopic view of the FCSEMS after 6 mo in place; D: Fluoroscopic image revealing enlargement of the common hepatic duct after SEMS removal. OLT: Orthotopic liver transplantation; FCSEMS: Fully covered stent-expandable metal stents.

Figure 5 Recurrent anastomotic stricture after fully covered stent-expandable metal stents distal migration.

Figure 6 Stricture recurrence after resolution.