LAUSR

Hepaticojejunal anastomotic obstruction (HJO) is diagnosed when contrast medium delivered via percutaneous transhepatic cholangiography (PTC) does not flow into the jejunum or when the hepaticojejunal anastomotic site cannot be identified using enteroscopy. HJO after liver transplantation (LT) is a rare biliary complication, and intractable HJO can lead to severe complications, including graft failure. Although surgical revision is the first choice for the treatment of HJO, it is an invasive procedure that can cause additional injury. With the advances in and benefits of endoscopic instruments and techniques, however, endoscopic treatments for hepaticojejunal anastomotic stricture (HJS) offer a promising lessinvasive procedure. Since the development of instruments and techniques for double-balloon enteroscopy (DBE), it has been possible to perform endoscopic retrograde cholangiography despite the length of the necessary passage, the strong adhesion of the Roux-enY limb to the peritoneum, and the difficult angulation of the hepaticojejunal anastomosis. The penetration and balloon dilatation of the HJO using combined percutaneous transhepatic cholangioscopy (PTCS) and DBE is performed. The anastomotic penetration procedure for HJO combined with PTCS and DBE compose the so-called “rendezvous technique.” Our institution has reported a pediatric case study of the rendezvous technique for HJO after living donor liver transplantation (LDLT). However, the longterm patency of the hepaticojejunal anastomosis after the rendezvous technique is still unclear. Therefore, in this study, we described our experience with the rendezvous technique for HJO after pediatric LDLT and the longterm outcomes after HJO treatment.