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Background To evaluate the efficacy of percutaneous and endoscopic therapeutic interventions for biliary strictures and leaks following LT in children. Methods Retrospective analysis of 49 consecutive pediatric liver transplant recipients (27 girls, 22 boys, mean age at transplant 3.9 years) treated at our institution from 1989 to 2019 for biliary leak and/or biliary stricture was performed. Minimally invasive approach was considered clinically successful if it resulted in patency of the narrowed biliary segment and/or correction of the biliary leak. Results Forty‐two patients had a stricture at the biliary anastomosis; seven had a biliary leak. After an average 13.8 years of follow‐up, long‐term clinical success with minimally invasive treatment (no surgery or re‐transplant) was achieved for 24 children (57%) with biliary stricture and 4 (57%) with biliary leaks. Eight patients required re‐transplant; however, only one was due to failure of both percutaneous and surgical management. For biliary strictures, failure of non‐surgical management was associated with younger age at stricture diagnosis (p < .02). Conclusions Percutaneous and endoscopic management of biliary strictures and leaks after LT in children is associated with a durable result in >50% of children.

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map was created to map the roles of each team member. Results from the observation were discussed at a team meeting to receive input and feedback from all members of the IR team. We have implemented changes in our workflow to address these issues. Patient transport is now solicited at earlier times to reflect appropriate transport lags. We found our team to be efficient in preparing the patient for the procedure with most of our delays being attributable to PACU bed availability. Conclusions: By analyzing our processes, inefficiencies in workflow and delays in coordination of patient care were identified. Implementation of targeted changes at our institution should lead to improved efficiency. Process mapping can be used to help other IR departments in identifying their inefficiencies.

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