Endosonography-guided alteration of upper surgical anatomy to facilitate endoscopic management of biliary cast syndrome post-liver transplantation.

The plan was to create an endoscopic gastrojejunostomy fistula using a LAMS close to the hepaticojejunostomy to permit subsequent endoscopic management of biliary cast syndrome with conventional ERCP and electrohydraulic lithotripsy (EHL). A plastic biliary stent (7 Fr × 9 cm) was placed into the left intrahepatic duct and a fully covered self-expandable metallic stent (8 mm × 60 mm; WallFlex, Boston Scientific) was placed in the right intrahepatic duct to facilitate passage of the fragmented stones ([1]). [Extracted from the article]