case_images: PMC11208879_01
case_images: Course of endoscopic dilatation for complete hepaticojejunostomy anastomotic stricture. Single-balloon endoscopy for biliary drainage. The presence of an ulcer scar-like mucosa surrounding the anastomosis is identified as the hepaticojejunostomy anastomotic stricture (a). White-light imaging during single-balloon endoscopy reveals a milky whitish area (b: triangle) present within the hepaticojejunostomy anastomotic stricture (b: asterisk), suggesting that a membranous and fibrosis layer affected continuous inflammation around the center of the anastomosis (within a scar-like feature). The endoscopic narrow band image clearly shows the mucosal concentration toward the center of the anastomosis, which enables a detailed evaluation of the stenotic area (c).
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case_images: The endoscopic narrow band image clearly showed the mucosal concentration toward the center of the anastomosis, which enabled a detailed evaluation of the stenotic area (Figure 1).
case_images: Hepaticojejunostomy anastomotic stricture puncture using a 23-G endoscopic injection needle. A 23-G endoscopic injection needle is used to penetrate the center of the blind lumen supporting the use of the milky whitish area as an indicator, and a pinhole is created in the stricture (a). The position of the proximal bile duct is confirmed using a contrast medium (b).
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case_images: After confirming the position of the proximal bile duct using a contrast medium with the needle (Figure 2), an endoscopic cannula and guidewire were inserted into the pinhole.
case_images: Dilatation of the hepaticojejunostomy anastomotic stricture. After the needle puncture, an endoscopic guidewire is inserted into the pinhole (a). A through-the-scope sequential balloon dilator (8 mm, REN; Kaneka) is used to dilate the stricture (b). We have confirmed that the hepaticojejunostomy anastomotic stricture is endoscopically dilated, and the stenosis has improved endoscopically (c). Subsequently, a plastic stent (7 French x 9 cm; Through & Pass; Gadelius) is inserted into the proximal bile duct (d).
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case_images: Through & Pass; Gadelius) was inserted into the proximal bile duct (Figure 3; Video S1). This endoscopic intervention led to positive outcomes.
case_images: Four months after the initial endoscopic dilatation, the patient underwent stent replacement owing to stent dysfunction. The lumen of the anastomosis is fully open when the plastic stent is removed (a). A through-the-scope sequential balloon dilator (8 mm, REN; Kaneka) is used to dilate the stricture (b, c), and then a plastic stent (8.5 French x 10 cm, SUZAKU; Kaneka) is inserted into the proximal bile duct (d).
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case_images: Four months after the initial endoscopic dilatation, the patient underwent stent replacement because of stent dysfunction as the stenosis at the bile duct jejunal anastomosis improved (Figure 4).