Introduction: Ischemic type biliary lesions (ITBL) in liver-transplanted patients are a difficult challenge to endoscopic therapy. ITBL has to be diffentiated by ERC from complications of choledocho-choledocho-side-toside-anastomosis and from papillary stenosis among others. Stenosis caused by ITBL as well as papillary stenosis can be treated successfully by ERC. We examined the outcome of endoscopic therapy in ITBL patients. Methods: From the beginning of the liver transplantation programme at our clinic in 1988 until now (11/1/1997) 935 orthotopic liver transplantations have been performed. Thereupon, 23 transplanted patients developed ITBL and most of them required endoscopic therapy. Therapy comprised endoscopic spincterotomy, balloon dilatation of stenoses, internal stenting and basket extraction of calculi. Results: 14 patients were treated due to progressive ITBL-induced stenoses by balloon dilatation subsequent to endoscopic sphincterotomy. In 6 out of 14 patients dilatation therapy failed due to rapid progression of ITBL. Calculi, sludge and debris could be extracted from 9 out of 14 patients. In 4 of these patients stenting was performed to treat stenoses in the donor-CBD or in the hepatic ducts. 5 patients presented a papillary stenosis requiting endoscopic sphinkterotomy. 12 of 23 ITBL patients deteriorated thus receiving retransplantation of the liver. The average time to retransplantation was 12 month. Endoscopic therapy could help many patients to survive for many month until retransplantation was possible. At the time of firstly diagnosing ITBL 3 patients presented only extrahepatic lesions (ITBL type I referring to the Neuhaus-classification) and 5 others circumscribed intrahepatic lesions (ITBL type II). These patients could by successfully treated by ERC. Further 15 patients were afflicted by multiple intraand extrahepatic stenoses (ITBL type III) thus always requiring retransplantation. Discussion: ITBL is a servere complication of liver transplantation. Endoscopic therapy is able to treat successfully many transplantationassociated stensoses. Thus, problems caused by cholestastis, cholangitis and cholelithiasis can be prevented or reduced significantly.Thereby, patients deteriorating progessively due to intraand extrahepatic stenoses (ITBL-type Ill) can be stabilized over many month to bridge the time until retransplantation. Moreover, patients with stenoses restricted to the extraor intrahepatic bile ducts (ITBL-type I and II) can be prevented from retransplantation by endoscopic measurements.