# Innovative Water-Wire Cannulation Technique for Managing Near-Complete Obstruction Due to Post-orthotopic Liver Transplant Anastomotic Strictures: A Report of Two Cases

## TL;DR

This paper introduces a new water-wire technique to treat severe bile duct narrowing after liver transplants, successfully used in two patients where standard methods failed.

## Contribution

The paper introduces a novel water-wire cannulation technique for managing post-transplant anastomotic strictures.

## Key findings

- The water-wire technique successfully enabled guidewire insertion in two patients with severe anastomotic strictures.
- The method offers a less invasive and safer alternative to traditional procedures like cholangioscopy or surgery.
- The technique's success highlights the need for innovative strategies in managing post-transplant biliary complications.

## Abstract

This report presents an innovative water-wire cannulation technique for managing challenging anastomotic strictures in post-orthotopic liver transplant patients, highlighting its successful application in two distinct cases. Anastomotic strictures pose a significant hurdle in hepatobiliary medicine, often complicating the course post-liver transplantation. Standard endoscopic retrograde cholangiopancreatography (ERCP) methods frequently encounter limitations in severe stricture cases, necessitating alternative approaches. The water-wire cannulation technique, introduced in this report, innovatively utilizes water injection to gently dilate the stricture, enabling successful guidewire insertion and subsequent standard endoscopic interventions. This method was effectively applied in two patients with severe anastomotic strictures, where conventional ERCP techniques were unsuccessful. The technique's effectiveness, demonstrated in these cases, offers a less invasive and potentially safer alternative to traditional options like cholangioscopy, percutaneous transhepatic cholangiography (PTC), or surgical revision, which carry higher risks and complexities. The water-wire cannulation technique's success emphasizes the need for innovative and adaptable strategies in hepatobiliary medicine, especially for managing post-transplant complications. Its potential applicability in a broader spectrum of biliary strictures warrants further exploration. Overall, this technique represents a significant advancement in the endoscopic management of complex biliary strictures, promising to enhance patient care and outcomes in hepatobiliary medicine.