Peroral cholangioscopy-guided laser stricturoplasty for intrahepatic benign biliary strictures (with video).

BACKGROUND AND AIMS: Endoscopic treatment of intrahepatic benign biliary strictures (BBSs) remains challenging despite repeated balloon dilation and long-term stent placement. The small-caliber, branching, and tortuous anatomy of intrahepatic ducts limits the feasibility of fully covered self-expandable metallic stents. Recently, endoscopic laser stricturoplasty (LAS) has emerged as a promising therapeutic option. We report a case series of 4 patients who underwent successful peroral cholangioscopy-guided LAS (POCS-LAS).

METHODS

This retrospective pilot study was conducted at Juntendo University Hospital. Patients who underwent POCS-LAS for intrahepatic BBSs between December 2024 and June 2025 were reviewed to evaluate the feasibility and safety of the procedure.

RESULTS

Six POCS-LAS sessions using a holmium:yttrium-aluminum-garnet laser were performed in 4 patients with postoperative intrahepatic BBSs (2 choledochojejunostomies, 1 right hepatectomy, and 1 cholecystectomy). All procedures were performed with the patient under saline irrigation with a median duration of 100 minutes. Technical success, defined as successful passage of the POCS through the stricture, was achieved in all cases. No adverse events were reported. Three patients became stent-free, and 1 patient remains under treatment.

CONCLUSIONS

This pilot study suggests that POCS-LAS is a technically feasible and potentially effective treatment for intrahepatic BBSs.