# Percutaneous Transhepatic Sphincterotome–Guided Management of Post–Living Donor Liver Transplant Biliary Anastomotic Stricture: An Innovative Approach

## TL;DR

A new method using a sphincterotome through a transhepatic route successfully treated a complex biliary stricture after liver transplantation, avoiding surgery.

## Contribution

The first reported use of a wire-guided sphincterotome via a percutaneous transhepatic route to manage post-LDLT biliary anastomotic stricture.

## Key findings

- Conventional methods failed to manage the biliary stricture in a post-LDLT patient.
- A novel transhepatic sphincterotome approach successfully treated the stricture.
- This approach avoided the need for major surgical intervention and its associated risks.

## Abstract

Post–liver transplantation biliary complications remain a serious concern and are associated with reduced patient and graft survival. Among various biliary complications, anastomotic stricture (AS) is the most frequent and challenging one. The frequency of AS after living donor liver transplantation (LDLT) is higher as compared to deceased donor liver transplantation. The management involves endoscopic retrograde cholangiopancreatography and/or percutaneous transhepatic biliary drainage, but refractory cases necessitate surgical revision. We present a case of complex biliary AS in a 63-year-old man after LDLT. The conventional approaches including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and cholangioscope-guided interventions remained unsuccessful. An innovative approach using a wire-guided sphincterotome through percutaneous transhepatic route successfully managed the complex post-LDLT AS. This is perhaps the first reported case of novel utilization of sphincterotome through transhepatic route for the management of AS in LDLT, averting major surgical interventions with related morbidity and mortality.