Endoscopic procedures are the treatment of choice;however, surgery is often required for refractory dis-ease.Here, we present the case report of a liver transplantrecipient with a bile leak forming a choledochoduodenalfistula, which was treated successfully by endoscopicstenting. A 67-year-old man underwent orthotopic livertransplantation for end-stage liver disease due to hep-atitis C virus infection. Biliary reconstruction was per-formed with end-to-end choledochocholedochostomywithout intraoperative complications. The patient wasdischarged from the hospital 16 days after transplan-tation.He was readmitted 10 days later because of painlessjaundice and elevation of liver function tests. Abdomi-nal ultrasound gave no evidence for mechanical cho-lestasis. Histologic analysis as well as serological testsrevealed hepatitis C reinfection.However, 3 weeks later abdominal ultrasonographyshowed intrahepatic bile ducts being dilated up to 4mm in diameter. Endoscopic retrograde cholangiogra-phy revealed biliary leakage at the level of the anasto-mosis without communication to other organs; conse-quently, a stent was placed within the common bileduct which resulted in timely abrogation of jaundice.Ten weeks later, the patient presented at our institu-tion again because of itching, jaundice, and elevatedcholestatic parameters. Magnetic resonance cholangio-pancreatography (MRCP) was performed, and it showeda signal-enhancing structure dorsal to the common bileduct leading to the small intestine (Fig. 1).After endoscopic examination, absence of the biliarystent was noticed. Retrograde endoscopic cholangiog-raphy showed a pearl necklace–like contrasted fistula-tion originating from the bile duct anastomosis andleading to the duodenum (Fig. 2). To localize the mouthof the fistula, 0.1% methylene-blue solution was in-jected into the distal choledochus (Fig. 3). Remarkably,the mouth of the fistula could be localized proximal tothe papilla vateri in the wall of the duodenum. Closingof the fistula was obtained by placing a 11.5-Frenchplastic endoprosthesis into the right hepatic duct. Thepatient recovered from jaundice after this procedure,without further events or complications.