Percutaneous Transhepatic Cholangioscopy for Biliary Complications After Kasai Portoenterostomy

Biliary atresia (BA) is a rare congenital biliary disorder treated with Kasai portoenterostomy, which preserves native liver function but often causes strictures and stones. We report two adult BA patients post-Kasai who underwent percutaneous transhepatic cholangioscopy (PTCS) for post-Kasai biliary complications including strictures, calculi, and cholangitis. PTCS enabled direct visualization, stone extraction, and stricture assessment despite altered anatomy. Targeted biliary drainage improved liver function and symptoms. PTCS appears to be a feasible, safe option for managing post-Kasai complications in adults and may delay liver transplantation.