Needle-Knife Fistulotomy With Percutaneous Transhepatic Cholangioscopy for Managing Complete Bilioenteric Anastomosis Occlusion

Untreated benign biliary stricture can lead to serious complications including recurrent cholangitis, biliary cirrhosis, hepatic failure, and death. Benign stricture of a postoperative anastomosis site is also a problematic issue after biliary surgery. Percutaneous transhepatic cholangioscopy (PTCS) with balloon dilatation is a recently introduced noninvasive therapeutic option for biliary stricture. Guidewire insertion through the stricture site is essential for the success of PTCS treatment. Recently, we treated a difficult case with complete bilioenteric anastomosis stricture that failed to allow passage of the guidewire for balloon dilation. The stricture was treated with artificial bilioenteric fistula using a needle-knife papillotome during the PTCS.