Abstract Text
Biliary complications after orthotopic liver transplantation (OLT) remain a major cause of morbidity. Complete hepatico-jejunal anastomotic disconnection is rare and often refractory to conventional endoscopic treatment. We report a 60-year-old man who underwent OLT with Roux-en-Y biliodigestive anastomosis for primary sclerosing cholangitis and developed recurrent cholangitis. Percutaneous cholangiography suggested complete anastomotic disconnection, and enteroscopic ERCP attempts failed. EUS-guided duodenojejunostomy was created using a lumen-apposing metal stent (LAMS), followed by transenteric ERCP. Due to incomplete biliary access, EUS-guided hepaticojejunostomy through the LAMS with placement of a fully covered metal stent was performed. At three-month follow-up, cholestasis improved and no further cholangitis occurred.