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DOI: 10.1055/a-1793-9775
Combined stent-by-stent and stent-in-stent deployment for malignant hilar biliary obstruction using a novel metal stent with flexible cell and slim delivery
A novel uncovered metal stent (Niti-S Multi-Purpose Type; Taewoong Medical, Seoul, Korea) designed specifically for multi-stenting in patients with malignant hilar biliary obstruction recently has been developed. This stent has a small size cell; however, it is flexible, can expand markedly, and has a 6-F slim delivery system ([Fig. 1]). Therefore, the stent makes passing stent cells easier in the stent-in-stent (SIS) method, while possibly preventing tumor ingrowth better than larger-cell stents. Moreover, the stent enables simultaneous insertion of two delivery systems, making the stent-by-stent (SBS) method straightforward [1]. Therefore, this novel stent is “multi-purpose,” i. e., it can be suitable for both SBS and SIS; thus, it can also be particularly useful for the combined SBS and SIS technique [2] [3] [4] [5].
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An 88-year-old man developed obstructive jaundice due to extrahepatic cholangiocarcinoma. Endoscopic retrograde cholangiography revealed severe Bismuth type IIIa stricture, which extended to the lower bile duct. After two guidewire placements into the right posterior and left hepatic ducts, two delivery systems of the novel stent were simultaneously inserted through the stricture. Subsequently, the posterior stent was deployed transpapillary across the stricture, and a catheter was progressively advanced over the posterior guidewire. The guidewire was inserted into the right anterior hepatic duct through the stent cell, and an additional stent was inserted and subsequently deployed in the SIS method. Finally, the left stent was deployed in the SBS configuration, with its distal end at the same level as that of the posterior stent ([Fig. 2], [Fig. 3], [Video 1]). The patient’s symptoms improved without the occurrence of adverse events, and recurrent biliary obstruction was not observed during the follow-up period.
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Video 1 Combined stent-by-stent and stent-in-stent method using a novel multi-purpose metal stent for a patient with malignant hilar biliary obstruction.
Quality:
This study described the use of a multipurpose metal stent for malignant hilar biliary obstruction. This novel stent can serve as a useful option while using any multi-stenting method.
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Competing interests
The authors declare that they have no conflict of interest.
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References
- 1 Inoue T, Ishii N, Kobayashi Y. et al. Simultaneous versus sequential side-by-side bilateral metal stent placement for malignant hilar biliary obstructions. Dig Dis Sci 2017; 62: 2542-2549
- 2 Maruki Y, Hijioka S, Wu SYS. et al. Novel endoscopic technique for trisegment drainage in patients with unresectable hilar malignant biliary strictures (with video). Gastrointest Endosc 2020; 92: 763-769
- 3 Saito T, Kanai S, Hamada T. et al. Combined stent-in-stent and side-by-side stenting for hilar cholangiocarcinoma using a novel braided and weaving metal stent. Endoscopy 2020; 52: E150-E151
- 4 Inoue T, Ibusuki M, Kitano R. et al. Combined side-by-side and stent-in-stent method for triple metal stenting in patients with malignant hilar biliary obstruction. Dig Endosc 2019; 31: 698-705
- 5 Inoue T, Kitano R, Yoneda M. Modified combined stent-by-stent and stent-in-stent method for tri-sectoral metal stenting in patients with malignant hilar biliary obstruction. Dig Endosc 2020; 32: e167-e168
Corresponding author
Publication History
Article published online:
10 June 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Inoue T, Ishii N, Kobayashi Y. et al. Simultaneous versus sequential side-by-side bilateral metal stent placement for malignant hilar biliary obstructions. Dig Dis Sci 2017; 62: 2542-2549
- 2 Maruki Y, Hijioka S, Wu SYS. et al. Novel endoscopic technique for trisegment drainage in patients with unresectable hilar malignant biliary strictures (with video). Gastrointest Endosc 2020; 92: 763-769
- 3 Saito T, Kanai S, Hamada T. et al. Combined stent-in-stent and side-by-side stenting for hilar cholangiocarcinoma using a novel braided and weaving metal stent. Endoscopy 2020; 52: E150-E151
- 4 Inoue T, Ibusuki M, Kitano R. et al. Combined side-by-side and stent-in-stent method for triple metal stenting in patients with malignant hilar biliary obstruction. Dig Endosc 2019; 31: 698-705
- 5 Inoue T, Kitano R, Yoneda M. Modified combined stent-by-stent and stent-in-stent method for tri-sectoral metal stenting in patients with malignant hilar biliary obstruction. Dig Endosc 2020; 32: e167-e168
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