Cutting balloon treatment of anastomotic biliary stenosis after liver transplantation: Report of two cases

Figure 1 Postoperative pathology. Nodular cirrhosis associated with hepatocyte and capillary bile cholestasis.

Figure 2 Magnetic resonance cholangiopancreatography findings. Post- orthotopic liver transplantation anastomotic stenosis of the choledochal duct, intra-hepatic bile duct dilation, and biliary sludge in the common hepatic duct and bilateral hepatic ducts; patient diagnosed with transplantation-related ischemic injury involving the biliary tract.

Figure 3 Percutaneous transhepatic cholangial drainage combined with balloon dilation. A: Anastomotic stenosis of the choledochal duct (straight arrow); B: The inflated balloon (diameter 8 mm, length 4 cm) has a waist at the narrowest part of the stenosis (straight arrow); C: Resolution of the stenosis after balloon dilation (straight arrow).

Figure 4 Cholangiography findings. The anastomotic stenosis was reduced by about 20 % (straight arrow).

Figure 5 Cutting balloon therapy. A: Cholangiography showed the development of anastomotic stenosis (straight arrow); B: The inflated cutting balloon (diameter 6 mm, length 4 cm) has a waist at the narrowest part of the stenosis (straight arrow); C: Resolution of the stenosis after balloon dilation (straight arrow).

Figure 6 Cholangiography findings. The anastomotic stenosis was resolved (straight arrow).

Figure 7 Postoperative pathology. A: Moderately differentiated hepatocellular carcinoma; B: Peripheral hepatic tissues revealed nodular cirrhosis pathologic changes.

Figure 8 Magnetic resonance cholangiopancreatography findings. Severe anastomotic stenosis of the choledochal duct, severe choledochectasia involving the intrahepatic bile ducts and left-right hepatic bile ducts above the anastomotic stomas; Patient diagnosed with biliary anastomotic stenosis.

Figure 9 Percutaneous transhepatic cholangial drainage combined with balloon dilation. A: Severe anastomotic stenosis of the choledochal duct (straight arrow); B: The inflated balloon (diameter 8 mm, length 4 cm) has a waist at the narrowest part of the stenosis (straight arrow); C: Resolution of the stenosis after balloon dilation (straight arrow).

Figure 10 Cutting balloon therapy. A: Cholangiography showed that the anastomotic stenosis had resolved; B: The inflated cutting balloon (diameter 5 mm, length 2 cm) has a waist at the narrowest part of the stenosis (straight arrow); C: Resolution of the stenosis after balloon dilation (straight arrow).

Figure 11 Cholangiography findings. The anastomotic stenosis was reduced by about 30% (straight arrow).