Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2023; 11(34): 8235-8241
Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8235
Management of post-liver transplantation biliary stricture inaccessible by endoscopic retrograde cholangiopancreatography: A case report
Yohan Lee, Chang Hwan Park, Eunae Cho, Ki-Hyun Kim
Yohan Lee, Chang Hwan Park, Eunae Cho, Ki-Hyun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea
Author contributions: Lee Y and Park CH wrote the manuscript; Park CH designed the research study; Lee Y, Park CH, Cho E, and Kim KH performed the research.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Hwan Park, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital, No. 42 Jebong-ro Donggu, Gwangju 61469, South Korea. gi00042@cnuh.com
Received: October 17, 2023
Peer-review started: October 17, 2023
First decision: November 1, 2023
Revised: November 15, 2023
Accepted: November 28, 2023
Article in press: November 28, 2023
Published online: December 6, 2023
Processing time: 44 Days and 22.8 Hours
Abstract
BACKGROUND

One challenging scenario in the treatment of biliary stricture is that post-liver transplantation (LT) biliary strictures cannot be accessed using endoscopic retrograde cholangiopancreatography (ERCP). Here, we report such a case that was successfully treated using a novel endoscopic technique.

CASE SUMMARY

A 60-year-old man presented with obstructive jaundice caused by a post-LT biliary stricture. He underwent LT for compensated alcoholic liver cirrhosis and hepatocellular carcinoma. Laboratory investigations unveiled a cholestatic pattern of abnormalities in liver function and a total bilirubin level of 16 mg/dL. Magnetic resonance cholangiopancreatography revealed a stricture extending from the right intrahepatic bile duct into the common hepatic duct. Severe postoperative deformities made accessing the ampulla of Vater with a side-viewing duodenoscope impossible. Percutaneous transhepatic biliary drainage (PTBD) was performed to treat biliary obstruction. Moreover, to resolve the stricture completely, a fully covered self-expandable metal stent (FC-SEMS) with a novel proximal retrievable string was deployed into the post-LT biliary stricture through the PTBD tract. Before inserting the stent through the PTBD tract, the stent with the distal string was manually inverted to ensure that the distal part with the string became the proximal part for later endoscopic removal. After 6 mo, the FC-SEMS was successfully removed without complications, as the string was pulled out using a forward-viewing gastroscope.

CONCLUSION

Deployment and endoscopic removal of an FC-SEMS with a novel proximal string through the PTBD tract may be a viable option for treating post-LT biliary strictures that are inaccessible by ERCP.

Keywords: Jaundice; Obstructive; Percutaneous transhepatic cholangioscopy; Self-expandable metallic stents; Case report

Core Tip: Post-liver transplantation biliary stricture is complex and involves many variables. There is no established method for its evaluation and treatment, and various approaches are needed depending on patient factors. While a fully covered self-expandable metal stent shows good effectiveness, it is premised on endoscopic access. This case report presents a new solution through percutaneous stent insertion and endoscopic removal in cases where endoscopic retrograde cholangiopancreatography is not possible.