LAUSR

To the editor, Postliver transplantation anastomotic stricture is one of the most common postliver transplantation complications with an incidence rate up to 15%.[1] Firstline management of ducttoduct anastomotic stricture is typically done endoscopically via endoscopic retrograde cholangiopancreatography (ERCP). This involves placement of a guidewire access across the stricture followed by a combination of sphincterotomy, balloon dilatation, and serial biliary stenting.[2] If failure to gain access across the stricture occurs with ERCP, then the use of percutaneous transhepatic cholangiography (PTC) allows access to the biliary system percutaneously via interventional radiology. A rendezvous procedure can be performed if access across the stricture is gained via PTC, and stents can be internalized via an ERCP thereafter.[3] The use of digital singleoperator cholangioscopy (DSOC) allows for direct visualization of the stricture and can be utilized via either the ERCP route or through the PTC, which may assist the operator in accessing the stricture. Surgery is required when both ERCP and PTC approaches fail, which carries significant perioperative morbidity. We herein present a successful case of a rendezvous procedure with ERCP/PTC for a completely occluded postliver transplantation anastomosis using the SpyGlass Direct Visualization System (Boston Scientific) by applying both transpapillary and percutaneous approaches.