Endoscopy 2019; 51(02): E30-E31
DOI: 10.1055/a-0767-6143
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Novel metallic stent designed for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction

Mamoru Takenaka
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Kentaro Yamao
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Kosuke Minaga
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Atsushi Nakai
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Shunsuke Omoto
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Ken Kamata
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Masatoshi Kudo
Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
› Author Affiliations
Further Information

Corresponding author

Mamoru Takenaka, MD, PhD
Department of Gastroenterology and Hepatology
Kindai University Faculty of Medicine
377-2 Ohno-Higashi
Osaka-Sayama, 589-8511
Japan   
Fax: +81-72-3672880   

Publication History

Publication Date:
23 November 2018 (eFirst)

 

In endoscopic bilateral stent-in-stent placement (SIS) in patients with hilar malignant biliary obstruction (HMBO), success depends on second stenting [1] [2] [3]. Some metallic stents employed in SIS are designed to be larger to allow easier second stenting [4] [5]. However, these large cells also increase the risk of ingrowth, resulting in weaker radial force and making it impossible for the stent to expand fully, thereby making second stenting difficult.

The Hilzo Biliary Moving Cell Stent (BCM Co., Ltd., Gyeonggi-do, South Korea) is a new metallic stent developed for SIS with a smaller cell size (4 mm) and the same high radial force all around the stent. The smaller cell size is expected to reduce ingrowth, and the high radial force results in higher expansion potential ([Fig. 1]). If the cell is small, second stenting during SIS can be difficult; however, the design of this novel stent allows each cell to expand from 4 mm to 10 mm ([Fig. 2]). This characteristic allows easier passage of the second stent through the cell.

Zoom Image
Fig. 1 The Hilzo Biliary Moving Cell Stent (BCM Co., Ltd., Gyeonggi-do, South Korea) is a new metallic stent developed for stent-in-stent application, with a smaller cell size (4 mm) and the same high radial force all around the stent. The smaller cell size is expected to reduce ingrowth, and the high radial force results in higher expansion potential. Source for stent: BCM
Zoom Image
Fig. 2 If the cell is small, second stenting via a stent-in-stent approach can be difficult; however, this stent allows each cell to expand from 4 mm to 10 mm. This characteristic allows easier passage of the second stent through the cell. Source for stent: BCM

An 82-year-old woman presented with obstructive jaundice due to HMBO and SIS was attempted for drainage. HMBO was confirmed via cholangiography and the first stent was inserted into the left bile duct through the hilar stricture and was successfuly guided to the right bile duct. Next, the contrast catheter was advanced under a guide and passed easily through the cell. We attempted to place the second stent without extending the mesh in the first stent. The tip of the second stent was easily passed through the cell without any resistance, and SIS was successful ([Fig. 3], [Fig. 4], [Video 1]).

Zoom Image
Fig. 3 We attempted to place the second stent without extending the mesh in the first stent. The tip of the second stent (arrow) was easily passed through the cell without any resistance.
Zoom Image
Fig. 4 Endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction using the novel stent was successful.

Video 1 Novel metallic stent designed for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction. Source for stent: BCM.


Quality:

The flexible cells of this novel stent allow expansion and convenience during second stenting in SIS.

This novel concept of each cell having the ability to expand has the potential to become a very useful option for SIS in patients with HMBO.

Endoscopy_UCTN_Code_TTT_1AR_2AZ

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Competing interests

None


Corresponding author

Mamoru Takenaka, MD, PhD
Department of Gastroenterology and Hepatology
Kindai University Faculty of Medicine
377-2 Ohno-Higashi
Osaka-Sayama, 589-8511
Japan   
Fax: +81-72-3672880   


Zoom Image
Fig. 1 The Hilzo Biliary Moving Cell Stent (BCM Co., Ltd., Gyeonggi-do, South Korea) is a new metallic stent developed for stent-in-stent application, with a smaller cell size (4 mm) and the same high radial force all around the stent. The smaller cell size is expected to reduce ingrowth, and the high radial force results in higher expansion potential. Source for stent: BCM
Zoom Image
Fig. 2 If the cell is small, second stenting via a stent-in-stent approach can be difficult; however, this stent allows each cell to expand from 4 mm to 10 mm. This characteristic allows easier passage of the second stent through the cell. Source for stent: BCM
Zoom Image
Fig. 3 We attempted to place the second stent without extending the mesh in the first stent. The tip of the second stent (arrow) was easily passed through the cell without any resistance.
Zoom Image
Fig. 4 Endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction using the novel stent was successful.