Hybrid placement technique for hepatic hilar obstruction using a new uncovered self-expandable metal stent
submitted 11. April 2019
accepted after revision 17. Juni 2019
01. Oktober 2019 (online)
Background and study aim Recently, a novel technique combining stent-in-stent (SIS) and side-by-side (SBS) technique (hybrid technique) has been reported. This technique may have application for hepatic hilar obstruction (HBO) because it reduces the number of times the stent mesh has to be passed. However, to the best our knowledge, evaluation of its use in that setting has not been reported. Recently, a new uncovered self-expandable metal stent (UCSEMS) has become available in Japan. The diameter of this stent delivery shaft is only 5.4 Fr, and the discrepancy between the guidewire and top of stent delivery system is strongly reduced. We herein report technical tips for hybrid metal stent deployment for high-grade HBO using this novel UCSEMS.
Hybrid metal stent deployment using he novel UCSEMS was attempted in seven patients. Technical success was obtained in all patients. Mean procedure time was 33.3 minutes (range, 27 to 43). Clinical success was obtained in six patients. Median stent patency was 109 days (range, 48 – 160 days).
In conclusion, the hybrid metal stent placement technique appears to be useful using the new UCSEMS because of its fine-gauge stent delivery system.
- 1 Lee TH, Kim TH, Moon JH. et al. Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant biliary strictures: a multicenter, prospective, randomized study (with video). Gastrointest Endosc 2017; 86: 817-827
- 2 Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction. Gastrointest Endosc 2010; 71: 195-199
- 3 Park DH, Lee SS, Moon JH. et al. Newly designed stent for endoscopic bilateral stent-in-stent placement of metallic stents in patients with malignant biliary strictures: multicenter prospective feasibility study (with video). Gastrointest Endosc 2009; 69: 1357-1360
- 4 Lee TH, Park do H, Lee SS. et al. Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant biliary strictures: a multicenter prospective study. Dig Dis Sci 2013; 58: 547-555
- 5 Inoue T, Okumura F, Naitoh I. et al. Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar obstructions (with videos). Gastrointest Endosc 2016; 84: 352-357
- 6 Naitoh I, Hayashi K, Nakazawa T. et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci 2012; 57: 3279-3285
- 7 Koshitani H, Nakagawa S, Itoh Y. Multiple self-expandable metal stent deployment for unresectable malignant hilar biliary strictures: combination of side-by-side and stent-in-stent methods. Dig Endosc 2016; 28: 621
- 8 Cotton PB, Eisen GM, Abakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE work shop. Gastrointest Endosc 2010; 71: 446-454
- 9 Kawamoto H, Tsutsumi K, Fujii M. et al. Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture (with videos). Gastrointest Endosc 2007; 66: 1030-1037
- 10 Lee TH, Moon JH, Choi HJ. et al. Third metal stent for revision of malignant hilar strictures. Endoscopy 2016; 48: 1129-1133