Use of a temporary plastic stent to facilitate the placement of multiple self expanding metal stents in malignant biliary hilar strictures

• Published in: Gastrointestinal endoscopy 2005-10, Vol.62 (4), p.605-609
• Main Authors: Hookey, Lawrence C., Le Moine, Olivier, Deviere, Jacques, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bile Duct Neoplasms - complications; Biological and medical sciences; Breast Neoplasms - complications; Breast Neoplasms - secondary; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholestasis, Extrahepatic - diagnostic imaging; Cholestasis, Extrahepatic - etiology; Cholestasis, Extrahepatic - surgery; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatic Duct, Common - diagnostic imaging; Hepatic Duct, Common - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver Neoplasms - complications; Male; Medical sciences; Metals; Middle Aged; Neoplasm Metastasis; Plastics; Prostatic Neoplasms - complications; Prostatic Neoplasms - secondary; Prosthesis Implantation - instrumentation; Stents; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.04.051

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.