Removal of biliary casts following orthotopic liver transplantation using a 2.5-mm ultra-fine choledochoscope via the 10-French T-tube tract

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.