Removal of biliary casts following orthotopic liver transplantation using a 2.5-mm ultra-fine choledochoscope via the 10-French T-tube tract
Year: 2026
Type: article
Study design: Case Report
Abstract: Removal of biliary casts following orthotopic liver transplantation using a 2.5-mm ultra-fine choledochoscope via the 10-French T-tube tract Bile cast (BC) syndrome is a rare complication of orthotopic liver transplantation (OLT), occurring in up to 4-18 % of OLT recipients, but is associated with morbidity, graft failure, the need for re-transplantation, and mortality [1].For patients with BCs after duct-to-duct anastomosis, endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment; however, those who fail often require percutaneous transhepatic biliary drainage or retransplantation [2].Here, we report, for the first time, a case of successful removal of BCs using a 2.5 mm-diameter ultra-fine choledochoscope via the 10 Fr percutaneous T-tube tract after OLT.A 56-year-old man, who underwent OLT 54 days prior due to liver cirrhosis with acute liver failure, had a 10-Fr T-tube indwelled below the anastomotic site during the procedure.In the past 10 days, he began to exhibit jaundice, and bile drainage decreased significantly.T-tube cholangiography revealed diffuse filling defects in the extrahepatic duct, extending into both hepatic ducts (▶ Fig. 1).Comprehensive treatment failed to produce satisfactory outcomes.The diagnosis of BCs was confirmed, and they were successfully removed using a novel shortlength (40 cm) ultra-fine (2.5 mm) choledochoscope in combination with one biopsy forceps and a stone removal bas-▶ Fig. 1 Preoperative T-tube cholan- giography revealed diffuse filling defects in the extrahepatic duct, extending into both hepatic ducts.▶ Fig. 2 The procedure of removing BCs following orthotopic liver transplantation using an ultra-fine choledochoscope via the percutaneous T-tube tract.a Under X-ray fluoroscopy, a guide wire was inserted through the T-tube into the duodenal cavity.b Complete removal of the 10-Fr T-tube.c Cholangioscopy revealed no abnormalities at the end of the common bile duct.d BCs were observed above the bile duct anastomosis.e Under direct vision of the choledochoscope, a biopsy forceps was used to pull the BCs into the bile duct below the anastomosis site.f BCs were extracted using a biopsy forceps.g BCs were extracted using a stone removal basket.h Inflammatory changes in the bile duct mucosa were observed in the hepatic portal region, accompanied by necrosis of the biliary duct epithelium.BC, biliary cast.
Source: Endoscopy
DOI: 10.1055/a-2839-9542
Institution: Shandong University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7154510661