Biliary cast syndrome: literature review and a single centre experience in liver transplant recipients.

Background: Biliary cast syndrome (BCS) is an unusual complication of orthotopic liver transplantation (OLTx), and its management is difficult. Limited success using endoscopic retrograde cholangiopancreatography (ERCP) or open exploration to clear casts has been reported, but failure usually results in re-transplantation. We aimed to review our experience with BCS and highlight a novel combined percutaneous and endoscopic approach for duct clearance.