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Minimally invasive radiologic–endoscopic recanalization or reconstruction of the common bile duct (CBD) for benign complete stenosis or complex iatrogenic lesions is routinely practiced at some tertiary centers [1,2]. Various techniques have been reported, including endoscopic ultrasound (EUS)-guided insertion of a magnet through a previous choledochoduodenostomy [1–4]. A 38-year-oldwomanwhohad undergone laparoscopic cholecystectomy 6 months earlier developed an iatrogenic biliary fistula with partial stenosis of the CBD. A biliary fully covered self-expanding metallic stent (FCSEMS) was placed for 2 months, but jaundice and pain recurred 3 months after its removal. Occlusive endoscopic retrograde cholangiography revealed complete stenosis at the mid CBD (●" Fig.1). A guidewire was maneuvered to perforate the CBD at a point distal to the stricture, and percutaneous transhepatic cholangiographic guidancewasused toperforate the hepatic duct with a guidewire at a point proximal to the stricture (●" Fig.2). However both guidewires tended to advance in the direction of the duodenal bulb, and several attempts to achieve a rendezvous in the subhepatic space failed. Therefore, we then advanced both guidewires along the preferential route to reach the duodenal bulb through the same hole, created by the guidewire (●" Fig.3a), thus avoiding significant duodenal injury. Next, with a Dormia basket that had been inserted endoscopically, the proximal guidewire was grasped (●" Fig.3a, ●" Fig.3b) and constant, controlled traction was applied to extra-anatomically establish continuity of the biliary tree (●" Fig.4a, ●" Fig.4b, ●" Fig.4c). An FCSEMS (Wallflex; Boston Scientific, Natick, Massachusetts, USA) was delivered for definitive treatment and scheduled to be replaced after 6 months (●" Fig.5). The patient was discharged Fig.2 a Percutaneous transhepatic cholangiogram showing common bile duct cutoff. b The guidewire that had been inserted percutaneously passed through the choledochal stenosis and reached duodenal bulb. Fig.1 Occlusive retrograde cholangiogram showing complete stenosis of the common bile duct (CBD) in a 38-year-old woman. This occurred after removal of a stent placed to manage an iatrogenic biliary fistula with partial stenosis of the CBD that had developed following laparoscopic cholecystectomy.

Extra-anatomical intraduodenal endoscopic–radiologic biliary rendezvous for treatment of iatrogenic complete stenosis of the common bile duct