Wire-guided exchange of an inside stent for complex biliary stricture after living donor liver transplantation.

Biliary strictures are a common complication of living donor liver transplantation (LDLT) with duct-to-duct reconstruction (1). Endoscopic stent insertion is considered to be the first-line treatment for this complication (2,3). To reduce duodenobiliary reflux, plastic stents are placed above the intact papilla (‘inside stent’) in some centers (2-4). Since the anastomosis of LDLT is more peripheral and more complex, compared with deceased donor liver transplantation, we have occasionally encountered technical difficulties in re-passing a guidewire through the anastomotic biliary stricture at the time of inside stent exchange. Here, we report a useful technique for the exchange of the inside stent in a patient with complex anastomotic biliary strictures after LDLT.