# Innovation in the percutaneous management of benign hepaticojejunostomy stricture with multiple lithiasis using SpyGlass Discover and biodegradable stent: a case report

## TL;DR

A 51-year-old woman with a complex bile duct issue was successfully treated using a minimally invasive percutaneous approach involving cholangioscopy and a biodegradable stent.

## Contribution

This case demonstrates a novel two-stage percutaneous strategy using SpyGlass Discover and biodegradable stents for treating complex bile duct strictures.

## Key findings

- The patient achieved complete clearance of intrahepatic stones and stricture resolution.
- Liver biochemistry normalized without early recurrence of the issue.
- The approach avoided open surgery and was effective in nondilated bile ducts.

## Abstract

We report the case of a 51-year-old female with a history of iatrogenic bile duct injury treated with hepaticojejunostomy in 2013 and reconstruction in 2016. She developed recurrent anastomotic stricture and intrahepatic lithiasis, with multiple failed surgical and endoscopic attempts, for that reason a two-stage percutaneous approach was performed: initial transhepatic cholangiography, crossing the stricture area and placing an internal-external biliary catheter; followed by cholangioscopy through a mature tract using the Spyglass Discover system, electrohydraulic lithotripsy of intrahepatic stones, endoluminal balloon plasty, and placement of biodegradable stent fifteen days later. The patient achieved complete clearance of intrahepatic stones, stricture resolution, and normalization of liver biochemistry without early recurrence. This case highlights the feasibility and efficacy of a minimally invasive percutaneous strategy combining cholangioscopy, lithotripsy, and biodegradable stenting for complex benign hepaticojejunostomy strictures, even in nondilated bile ducts, avoiding the morbidity of open surgery.