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Biliary stricture is the most frequent complication after liver transplantation, and ranges from 5 to 32%. Biliary strictures in transplanted patients can be anastomotic and non-anastomotic. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the first-line treatment modality for anastomotic biliary strictures and in selected cases of non-anastomotic biliary strictures. Anastomotic biliary strictures arise at the site of the choledocho-choledochostomy. ERCP with multiple plastic stent placements is the first-line treatment of anastomotic biliary strictures, with long-term success rates ranging from 90 to 100%. Also covered self-expandable metal stents can be used for dilation of these strictures, but not routinely.

Anastomotic biliary stricture after liver transplantation

Estenosis biliar anastomótica después de trasplante de hígado


Estenose biliar anastomótica após transplante de fígado


Анастомотическая стриктура жёлчных протоков после трансплантации печени

肝移植术后吻合口胆管狭窄


Sténose biliaire anastomotique après transplation du foie


Estenose pós-operatória do colédoco


Sténose post-opératoire du canal cholédoque


Послеоперационный стеноз общего желчного протока

Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.

Postoperative CBD stenosis

术后CBD狭窄


Estenosis posoperatoria del colédoco


There are several major indications for the endoscopic drainage of malignant common bile duct obstruction. There are several types of drainage: a preoperative biliary drainage, which is performed in selected cases (delayed surgery, high bilirubin levels, itching, cholangitis), a biliary drainage before neo-adjuvant therapies, and a biliary drainage for palliation. According to the ESGE guidelines, palliative biliary drainage should be performed according to life expectancy. If less than 4 months, plastic stent placement is recommended; if longer than 4 months, a self-expandable metal stent should be placed. In any case, every single patient should be evaluated for the best treatment. In particular, since uncovered self-expandable metal stents are impossible to remove, malignancy must be evidenced before placement of these stents.

Common bile duct stricture due to an inoperable pancreatic head cancer: metal stent placement 

由于不能手术的胰头癌导致的胆总管狭窄：金属支架置入


Estenose do colédoco devido a uma câncer inoperável na cabeça do pâncreas: colocação de stent metálico


Sténose du canal cholédoque causé par un cancer de la tête du pancréas inopérable: mise en place d'une prothèse en métal


Стриктура общего желчного протока по поводу неоперабельного рака поджелудочной железы: установка металлического стента

Estenosis del colédoco en virtud de un cáncer inoperable en la cabeza del páncreas: colocación de stent metálico


ERCP：抗血小板（氯吡格雷）治疗患者的急性胆管炎


ЭРХПГ: острый холангит после антиагрегантной терапии с клопидогрелом 

ERCP: colangite aguda em paciente com terapia antiplaquetária (clopidogrel)


CPRE : angiocholite aiguë chez un patient sous traitement antiplaquettaire (clopidogrel)


Acute cholangitis is a clinical emergency. Urgent biliary drainage and bile ducts disobstruction represent the only effective therapy. Acute cholangitis is a result of bile flow obstruction and bile infection. Both ERCP and percutaneous biliary drainage are valid therapeutic options associated with antibiotics. ERCP with biliary sphincterotomy and stones clearance is less invasive and generates less discomfort as compared to percutaneous biliary drainage. Percutaneous biliary drainage is reserved for patients in poor or bad clinical conditions and co-morbidities, unavailability of ERCP or surgically altered anatomy unsuitable for ERCP. We present a case of an 81-year-old female patient with antiplatelet therapy (Plavix®/clopidogrel) and cholangitis. During ERCP, there was evidence of previously unreported small biliary sphincterotomy. Consequently, biliary balloon dilation followed by stones extraction were performed. A nasobiliary drainage was also placed to flush the bile ducts with saline over 24 hours. 

ERCP: acute cholangitis in a patient with antiplatelet (clopidogrel) therapy

CPRE: colangitis aguda en paciente con terapia antiplaquetaria (clopidogrel)


Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure in digestive endoscopy. Cannulation in ERCP requires optimal training, understanding of papillary anatomy, and especially understanding cholangiography and pancreatography imaging. The choice of cannulation technique (contrast vs. wire) depends on the expertise of local teams, even if the injection of a small amount of contrast can better show the way and direction of the ducts. It is essential to choose the appropriate accessories according to the case that's being dealt with. Here, we present the case of a hemophilic 71-year-old male patient with elevated liver enzymes, and magnetic resonance cholangiopancreatography (MRCP) was performed to detect common bile duct stones. The patient has also a left lobe liver hematoma which originated from mild trauma. Endoscopically, the papilla of this patient presented with an ectropion and long infundibulum. Biliary cannulation was performed with the double wire technique, first cannulating Wirsung’s duct which straightened the siphon. After a large biliary sphincterotomy, the stone was removed with a Dormia basket. A small pancreatic stent was placed to prevent pancreatitis.

Double wire biliary cannulation, biliary stone removal and pancreatic stent placement

Canulação da via biliar com fio duplo, remoção do cálculo biliar e colocação do stent pancreático


Canulation biliaire à fil double, ablation de calcul biliaire et pose de stent pancréatique


双丝胆管插管，胆道结石取出和胰支架置入


Катетеризация желчных протоков, удаление желчных камней и стентирование поджелудочной железы 

Canulación de la vía biliar con hilo doble, retirada del cálculo biliar y colocación del stent pancreático


Diagnóstico de emergencia con tratamiento por ecografía endoscópica (EUS) y colangiopancreatografía retrógrada endoscópica (CPRE) de un cálculo impactado en la papila


Diagnostic d'urgence par échographie endoscopique et traitement par CPRE d'un calcul dans la papille


This is the case of a 31-year-old patient admitted to the emergency care unit for abdominal pain, vomiting, and jaundice. He underwent emergency EUS which was positive for a stone impacted in the papilla and gallbladder lithiasis. 

Emergency diagnosis with endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) treatment of an impacted stone in the papilla

Экстренная диагностика с помощью эндоскопического ультразвука (EUS) и эндоскопической ретроградной холангиопанкреатографии (ERCP) для лечения ущемлённого камня в сосочке

用内镜超声（EUS）和内镜逆行胰胆管造影术（ERCP）对乳头中的受影响石头进行紧急诊断


Diagnóstico emergencial com tratamento por ultrassom endoscópico (EUS) e colangiopancreatografia retrógrada endoscópica (ERCP) de um cálculo impactado na papila


经皮经肝胆道支架置入术和EUS引导下的胰腺肿瘤活检


Чрескожное чреспечёночное стентирование печени и EUS биопсия опухоли поджелудочной железы

Pose de stent biliaire transhépatique en percutané et biopsie d'une tumeur du pancréas guidée par échographie


Implante de stent biliar percutáneo transhepático y biopsia guiada por EUS (ecografía endoscópica) de un tumor pancreático


Implante de stent biliar percutâneo trans-hepático e biópsia guiada por EUS (ultrassonografia endoscópica) de um tumor pancreático


Percutaneous treatment is a well-recognized treatment modality in the management of malignant biliary obstruction. This video demonstrates the steps of an EUS-guided biopsy of a pancreatic tumor in a patient who underwent a previous failure of endoscopic biliary drainage and placement of a duodenal uncovered stent.  The second step of the procedure was a transhepatic percutaneous stenting of the malignant biliary stricture.

Percutaneous transhepatic biliary stenting and EUS-guided biopsy of a pancreatic tumor

Procedimiento en vivo en quirófano híbrido: ablación percutánea por radiofrecuencia (ARF) de metástasis hepática de cáncer colorrectal


Percutaneous radiofrequency ablation (RFA) is not the best therapeutic option for the destruction of liver metastases of colorectal cancer. Surgical resection is still considered as the gold standard. However, it may not be possible in some patients, for various reasons, including liver function and the condition of the patient. This video shows this technique applied in a fragile patient with a complex past surgical history which would make surgical resection very complicated and risky.





Live procedure in a hybrid operating room: percutaneous radiofrequency ablation (RFA) of a colorectal liver metastasis 

混合手术室的实时操作：经皮射频消融（RFA）的结直肠肝转移


LIVE процедура в гибридной операционной комнате: чрескожная радиочастотная абляция (RFA) метастазов в печени при колоректальном раке

Opération live dans une salle d'opération hybride: ablation percutanée par radiofréquence d'un métastase colorectal du foie


Procedimento ao vivo em sala de cirurgia híbrida: ablação percutânea por radiofrequência (ARF) de metástase hepática de câncer colorretal


This is the case of a 60-year-old man with a large left kidney stone (>3cm) taking up the entire renal pelvis and lower calyceal cavities. Under general anesthesia, the patient is placed in a supine modified lithotomy position, with a 3L water bag underneath the left lumbar fossa to raise it. The left leg is straight whereas the right leg is put on a leg brace flexed. 

A cystoscopy is performed in order to identify the left ureteral orifice and introduce a 7 French beveled ureteral stent. This stent is connected to a Foley catheter. A contrast agent is injected into the ureteral stent. 

The kidney’s lower pole is punctured with an 18 Gauge hypodermic needle, making sure to stay in contact with the stone. A rigid Lunderquist® guidewire is passed into the needle. The pathway is dilated using metallic coaxial dilators and with a dilation balloon until an Amplatz® renal sheath is placed. The sheath will then be extended. 

A nephroscopy is performed to identify the stone, fragment and aspirate it partially with the LithoClast Master® intracorporeal lithotripter. Some large fragments will be withdrawn with crocodile forceps. The lithotripter system fails to remove the residual stone. A Malecot®-type nephrostomy tube is used and the ureteral stent is replaced by means of a double J catheter. 

Percutaneous nephrolithotomy

Nephrolithotomie percutanée

Чрескожная нефролитотомия

经皮肾镜取石术


Nefrolitotomia percutânea


Nefrolitotomía percutánea


video lecture

Nesta palestra de especialista, o Dr. Eduardo Houghton revisa a colecistostomia percutânea.


Colecistostomia percutânea

Cholécystectomie percutanée


In this key lecture, Dr. Eduardo Houghton reviews percutaneous cholecystostomy.

Percutaneous cholecystostomy

Чрескожная холецистэктомия


In this key lecture, Dr. Horacio D'Agostino looks into biliary tract drainage.

Drainage of biliary tract

Drainage des voies biliaires


Дренирование желчных протоков


Nesta palestra magistral, o Dr. Horacio D'Agostino aborda a drenagem do trato biliar.


Drenagem das vias biliares

Nouvelles possibilités en endo-échographie biliopancréatique


Nesta palestra de especialista, o Dr. Guido Costamagna aborda novas possibilidades na endossonografia biliopancreática (EUS).


Novas possibilidades na endossonografia biliopancreática (EUS)

Новые возможности в билиопанкреатической эндоскопической ультрасонографии


In this authoritative lecture, Dr. Guido Costamagna looks into new possibilities in biliopancreatic endosonography (EUS).

New possibilities in biliopancreatic endosonography (EUS)

Nesta palestra de especialista, o Dr. Benoît Gallix aborda o seguinte tema: qual técnica de imagem para qual paciente?


Qual técnica de imagem para qual paciente?

In this authoritative lecture, Dr. Benoît Gallix looks into the following issue: which imaging technique for which patient?

Which imaging technique for which patient?

Какой метод визуализации использовать для каких пациентов?


Quelle technique d'imagerie pour quel patient ?


Traitement percutané de lithiase biliaire


Чрескожное лечение литиаза желчного пузыря


Nesta palestra de especialista, o Dr. Eduardo Houghton aborda o tratamento percutâneo da litíase biliar.


Tratamento percutâneo da litíase biliar

In this authoritative lecture, Dr. Eduardo Houghton looks into the percutaneous treatment of biliary lithiasis.

Percutaneous treatment of biliary lithiasis

Лечение доброкачественной стриктуры желчных протоков


Nesta palestra de especialista, o Dr. Mariano Gimenez aborda o manejo da estenose benigna da via biliar.


Manejo da estenose benigna da via biliar

In this authoritative lecture, Dr. Mariano Gimenez looks into the management of benign biliary stricture.

Management of benign biliary stricture

Prise en charge de sténose biliaire bénigne


Prise en charge de sténose biliaire maligne


Лечение злокачественной стриктуры желчных протоков


Nesta palestra magistral, o Dr. Mariano Palermo aborda o manejo da estenose maligna da via biliar.


Manejo da estenose maligna da via biliar

In this key lecture, Dr. Mariano Palermo looks into the management of malignant biliary stricture. 

Management of malignant biliary stricture

Nesta palestra de especialista, o Dr. Dong Ki Lee cobre o uso de imãs nas estenoses benignas da via biliar (EBVB) totais.


Uso de imãs na estenose benigna da via biliar (EBVB) total

Utilisation d'aimants pour sténose biliaire totalement bénigne


In this authoritative lecture, Dr. Dong Ki Lee covers the use of magnets in total benign biliary strictures (BBS).

Focus on Hybrid Endoscopic and Percutaneous Image-Guided Surgery