Context: Biliary cast syndrome is an unusual complication of orthotopic liver transplantation with serious clinical implications. Surgical management has been the mainstay of treatment. Endoscopic techniques are recently described in the successful removal of biliary casts. Peroral single operator cholangioscopy is useful for direct visualization of bile ducts, tissue sampling and therapeutic applications.
Case report: We report here a post liver transplant patient who underwent successful complete endoscopic removal of biliary cast using single operator cholangioscopy in a single sitting.
Conclusion: Single operator cholangioscopy provides a safe means of diagnosing and treating patients with biliary cast syndrome.