BACKGROUND: Although endoscopic palliation of malignant biliary hilar obstruction is preferable to surgery or percutaneous drainage, it remains technically challenging. This is especially true when multiple self-expanding metal stents (SEMS) are placed, because difficulty is commonly encountered in passing the second SEMS at the level of the previously deployed initial stent. We have devised a method of deploying multiple metal stents by using a temporary plastic stent, which makes deployment of the second stent much easier. METHODS: After guidewire placement, a plastic stent is deployed in a subhilar position. The initial SEMS is deployed, with the plastic stent maintaining a passage for the second SEMS. After the second SEMS is deployed, the plastic stent is retrieved. OBSERVATIONS: This technique has been used successfully in 7/8 patients, all of whom presented with symptomatic jaundice secondary to malignant hilar obstruction of various etiologies (cholangiocarcinoma, n=4; metastatic disease, n=3; and hepatocellular carcinoma, n=1). Drainage was successful in all cases, with significant improvement in symptoms and cholestasis. CONCLUSIONS: This simple technique lessens the technical difficulty of placing bilateral hilar SEMS.
BACKGROUND: Although endoscopic palliation of malignant biliary hilar obstruction is preferable to surgery or percutaneous drainage, it remains technically challenging. This is especially true when multiple self-expanding metal stents (SEMS) are placed, because difficulty is commonly encountered in passing the second SEMS at the level of the previously deployed initial stent. We have devised a method of deploying multiple metal stents by using a temporary plastic stent, which makes deployment of the second stent much easier. METHODS: After guidewire placement, a plastic stent is deployed in a subhilar position. The initial SEMS is deployed, with the plastic stent maintaining a passage for the second SEMS. After the second SEMS is deployed, the plastic stent is retrieved. OBSERVATIONS: This technique has been used successfully in 7/8 patients, all of whom presented with symptomatic jaundice secondary to malignant hilar obstruction of various etiologies (cholangiocarcinoma, n=4; metastatic disease, n=3; and hepatocellular carcinoma, n=1). Drainage was successful in all cases, with significant improvement in symptoms and cholestasis. CONCLUSIONS: This simple technique lessens the technical difficulty of placing bilateral hilar SEMS.
Authors: Tae Hoon Lee; Do Hyun Park; Sang Soo Lee; Hyun Jong Choi; Jun Kyu Lee; Tae Hyeon Kim; Jong Hyeok Kim; Seok Jeong; Sang-Heum Park; Jong Ho Moon Journal: Dig Dis Sci Date: 2012-08-11 Impact factor: 3.199
Authors: Srinivas R Puli; Nikhil Kalva; Smitha R Pamulaparthy; Matthew L Bechtold; Micheal D Cashman; Fritz-Henry Volmar; Sonu Dhillon; Michael F Shekleton; Norman C Estes; David Carr-Locke Journal: Indian J Gastroenterol Date: 2013-10-25