2026 Volume 68 Issue 6 Pages 1171-1177
A 75-year-old man diagnosed with perihilar bile duct cancer underwent extended left hepatic lobectomy, caudate lobectomy, extrahepatic cholangiectomy, and biliary reconstruction. The postoperative specimens suggested primary sclerosing cholangitis. Postoperatively, the patient repeatedly developed cholangitis. Cholangitis was suspected because of anastomotic stenosis. Balloon enteroscopy-assisted ERCP revealed pinhole-like narrowing at the anastomosis and an approximately 10 mm bile duct stricture. A guidewire was passed; however, balloon dilation was not possible. A spiral dilator was instead used to dilate the stenosis, and a biliary stent was placed successfully. Thus, use of a spiral dilator can help manage postoperative biliary-enteric anastomotic stenosis in patients with primary sclerosing cholangitis, especially if traditional balloon dilation is challenging or unsuccessful.
