Endoscopic management of biliary complications after liver transplantation: An evidence-based review

Figure 1 Biliary strictures at endoscopic retrograde cholangiopancreatography. A: Early and incipient anastomotic stricture (arrow) with upstream biliary dilation; B and C: Late and high-grade anastomotic stricture (arrow) > 1 year after deceased-donor liver transplantation, with a large stone located upstream from the stricture (arrow); D: Combination of anastomotic (arrow) and non-anastomotic (arrow heads) strictures.

Figure 2 Biliary leaks. A: Biloma (arrow) resulting from anastomotic leakage early after liver transplantation as shown at magnetic resonance cholangiopancreatography; B: Anastomotic leakage (arrow) at the level of an anastomotic stricture (arrow head) early after liver transplantation as shown at endoscopic retrograde cholangiopancreatography (ERCP); C: Multiple leak sites from the cut surface in a split liver transplantation patient (arrows) as shown at ERCP with a plastic biliary stent in place.

Figure 3 Endoscopic treatment of an anastomotic biliary stricture with upstream sludge and downstream stone after living donor liver transplantation. A: Anastomotic biliary stricture with upstream sludge (arrows) and downstream stone (arrowhead); B: Stricture dilation using a 10-mm in-diameter balloon; C: 10-F plastic biliary stent in place; D: Absence of residual stricture at late follow-up.

Figure 4 Elongated intraductal filling defects in the choledocus and common hepatic duct suggestive of biliary casts (arrows) (A) and endoscopic view of the successfully removed cast (B).

Figure 5 Endoscopic treatment of an anastomotic biliary stricture after deceased donor liver transplantation. A: Late, high-grade, anastomotic stricture (arrow) with a stone partially concealed by the endoscope; B: Stricture dilatation with a 4-mm in-diameter balloon; C: Three 10-Fr plastic stents in place, no residual stone; D: Balloon occlusion cholangiogram showing stricture disappearance at the end of treatment (arrow).