AbbreviationsBAbiliary atresiaBWbody weightDBEdouble‐balloon enteroscopyHJOhepaticojejunal anastomotic obstructionHJShepaticojejunal anastomotic strictureIHBDintrahepatic bile ductLDLTliving donor liver transplantationLTliver transplantationPTBDpercutaneous transhepatic biliary drainagePTCpercutaneous transhepatic cholangiographyPTCSpercutaneous transhepatic cholangioscopyTO THE EDITOR:Hepaticojejunal anastomotic obstruction (HJO) is diagnosed when contrast medium delivered via percutaneous transhepatic cholangiography (PTC) does not flow into the jejunum or when the hepaticojejunal anastomotic site cannot be identified using enteroscopy. HJO after liver transplantation (LT) is a rare biliary complication, and intractable HJO can lead to severe complications, including graft failure.Although surgical revision is the first choice for the treatment of HJO, it is an invasive procedure that can cause additional injury. With the advances in and benefits of endoscopic instruments and techniques, however, endoscopic treatments for hepaticojejunal anastomotic stricture (HJS) offer a promising less‐invasive procedure. Since the development of instruments and techniques for double‐balloon enteroscopy (DBE), it has been possible to perform endoscopic retrograde cholangiography despite the length of the necessary passage, the strong adhesion of the Roux‐en‐Y limb to the peritoneum, and the difficult angulation of the hepaticojejunal anastomosis. The penetration and balloon dilatation of the HJO using combined percutaneous transhepatic cholangioscopy (PTCS) and DBE is performed. The anastomotic penetration procedure for HJO combined with PTCS and DBE compose the so‐called “rendezvous technique.”Our
Liver Transplantation – Wiley
Published: Jan 1, 2018
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