Use of a Soehendra stent retriever in dilation of an anastomotic biliary stricture in a post-liver transplant patient.

Occasionally, bile duct strictures in patients who have undergone liver transplantation are impossible to traverse, dilate, and stent. Herein we present a novel technique for the dilation of a recalcitrant stricture using the Soehendra stent retriever device. A 57-year-old woman with a history of orthotopic liver transplantation presented to the emergency department with pruritus and right-upper quadrant abdominal pain of 2 days’ duration. Results of laboratory tests were relevant for platelets (93000/mm3), alkaline phosphatase (181U/L), and alanine transaminase (80U/L). Endoscopic ultrasound revealed that the common bile duct (CBD) was dilated to 11mm, with a 5-mm stone in the distal duct. Another endoscopist attempted endoscopic retrograde cholangiopancreatography (ERCP) but cannulation was not achieved. Repeat ERCP displayed a fusiform distal CBD dilated to 20mm, with a tight 4-mm-long concentric stricture at the anastomosis (●" Fig.1a,●" Video 1). Although the guidewire was able to traverse the stricture, it was impossible to advance the tapered-tip biliary catheter (Conmed, Utica, New York, USA), the Titan balloon dilation catheter (Cook Medical, Winston-Salem, North Carolina, USA) or the Soehendra 7-Fr dilator. The wire was left in place and a 7-Fr Soehendra stent retriever was advanced over the guidewire using forward-clockwise rotation (●" Fig.1b,●" Fig.1c). The stent retriever passed through the stricture and enabled the passage of an 8-mm Titan balloon,