The drainage method for malignant hilar biliary obstruction (MHBO) has not been established. A 6-mm slim fully covered self-expandable metallic stent (FCSEMS) prevents tumor ingrowth and can be exchanged, but it carries the risk of segmental cholangitis by blocking the side branches of the bile duct [1]. A novel slim multi-hole FCSEMS (slim-MHSEMS) could resolve this issue [2]
[3]
[4].
A 60-year-old man with pancreatic head cancer presented with Bismuth type IIIb MHBO ([Fig. 1]). Bilateral stenting was performed using the slim-MHSEMS (HANARO Biliary Multi-hole Benefit; M.I. Tech Co., Ltd., Pyeongtaek, South Korea), which has six 1.6-mm holes evenly spaced along its circumference ([Fig. 2]). The diameter of the delivery system of the slim-MHSEMS was 5.9-Fr, and simultaneous deployment was possible. Two slim-MHSEMSs (6 mm in diameter and 12 cm in length) were deployed simultaneously in side-by-side placement across the papilla ([Video 1]). The tip of one slim-MHSEMS was placed in the B2 branch, and the contrast medium remained in B3 and B4 ([Fig. 3]). However, it disappeared on an X-ray image taken the next day. Furthermore, the X-ray image revealed the pneumobilia of B4 ([Fig. 4]).
Fig. 1 A fluoroscopic image presenting Bismuth type IIIb malignant hilar biliary obstruction.
Fig. 2 Enlarged image of the tip of the slim multi-hole self-expandable metallic stent (MHSEMS). It has six 1.6-mm holes evenly spaced along its circumference.
Two slim MHSEMSs (6 mm in diameter and 12 cm in length) were deployed simultaneously in side-by-side placement.Video 1
Fig. 3 Slim-MHSEMSs were simultaneously deployed using side-by-side method. Yellow arrows: the proximal end of a slim MHSEMS in the B2 and B5 branches.
Fig. 4 An X-ray image taken the next day reveals the disappearance of the contrast agent. Yellow arrows: pneumobilia in the B4 branch.
A fully covered SEMS has not been placed for MHBO due to the risk of segmental cholangitis. Because of the holes and diameter of the SEMS, the slim-MHSEMS can be safely and effectively placed for MHBO without obstructing the bile duct branches. Furthermore, simultaneous side-by-side placement of slim-MHSEMSs was easier than the previous bilateral stenting procedure. This report presents the first case of simultaneous side-by-side placement of slim-MHSEMSs for MHBO.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
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