Endoscopy 2021; 53(05): E162-E163
DOI: 10.1055/a-1224-3698
E-Videos

Simultaneous triple stent-by-stent deployment following endobiliary radiofrequency ablation for malignant hilar biliary obstruction

Tadahisa Inoue
Department of Gastroenterology, Aichi Medical University, Aichi, Japan
,
Rena Kitano
Department of Gastroenterology, Aichi Medical University, Aichi, Japan
,
Mayu Ibusuki
Department of Gastroenterology, Aichi Medical University, Aichi, Japan
,
Yuji Kobayashi
Department of Gastroenterology, Aichi Medical University, Aichi, Japan
,
Kiyoaki Ito
Department of Gastroenterology, Aichi Medical University, Aichi, Japan
,
Masashi Yoneda
Department of Gastroenterology, Aichi Medical University, Aichi, Japan
› Institutsangaben
 

The simultaneous triple stent-by-stent (SBS) technique can prevent failure of the third stent insertion for trisectoral metal stenting in patients with malignant hilar biliary obstruction (MHBO) [1] [2] However, simultaneous insertion of three stent delivery systems is often challenging, especially for tight strictures. Endobiliary radiofrequency ablation (RFA), which can prolong stent patency in MHBO [3], renders the stricture and tumor degenerative [4], resulting in decreased tightness of the stricture. Here, we describe an initial case of simultaneous triple SBS deployment following endobiliary RFA for unresectable MHBO.

A 78-year-old man developed obstructive jaundice because of Bismuth type IIIa MHBO. As diameter of the common bile duct was large, we chose the triple SBS method. After placement of three guidewires into the left hepatic duct (LHD), anterior branch of the right hepatic duct (a-RHD), and posterior branch of the RHD (p-RHD), the RFA catheter (Habib EndoHPB catheter; Boston Scientific, Marlborough, Massachusetts, USA) was introduced over the LHD guidewire, and the stricture of the LHD was subsequently ablated for 90 seconds at 7 W (VIO300 D generator; ERBE Elektromedizin GmbH, Tübingen, Germany). Then, the stricture of the RHD was also ablated over the p-RHD guidewire using the same settings. After RFA, three metal stents (Zeo Stent V; Zeon Medical, Tokyo, Japan) were simultaneously introduced and passed smoothly through the stricture. Finally, the stents were released and placed in the order LHD, p-RHD, a-RHD ([Fig. 1], [Video 1]). All stents used were 8 mm in diameter and 80 mm in length. The patient’s symptoms improved immediately, with no adverse events.

Zoom Image
Fig. 1 Triple stent-by-stent deployment. a, b After three guidewires were inserted across the Bismuth type IIIa stricture, radiofrequency ablation was performed to the left and right hepatic duct strictures. c Three metal stent delivery systems were simultaneously introduced to the left, right posterior, and right anterior hepatic ducts. d The stents were released and placed in a stent-by-stent manner with their distal ends at the same level.

Video 1 Simultaneous triple stent-by-stent deployment following endobiliary radiofrequency ablation in a patient with high-grade malignant hilar biliary obstruction.


Qualität:

Endobiliary RFA, which can help prolong the patency of metal stents in patients with MHBO, may also be useful for the simplification of simultaneous insertion of delivery systems.

Endoscopy_UCTN_Code_TTT_1AR_2AZ

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Competing interests

Dr. Inoue has received honoraria from Boston Scientific Japan and Japan Lifeline Co., Ltd. All other authors declare that they have no conflict of interest.


Corresponding author

Tadahisa Inoue, MD, PhD
Department of Gastroenterology
Aichi Medical University
1-1 Yazakokarimata
Nagakute, Aichi 480-1195
Japan   
Fax: +81-561-633208   

Publikationsverlauf

Publikationsdatum:
20. August 2020 (online)

© 2020. Thieme. All rights reserved.

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Zoom Image
Fig. 1 Triple stent-by-stent deployment. a, b After three guidewires were inserted across the Bismuth type IIIa stricture, radiofrequency ablation was performed to the left and right hepatic duct strictures. c Three metal stent delivery systems were simultaneously introduced to the left, right posterior, and right anterior hepatic ducts. d The stents were released and placed in a stent-by-stent manner with their distal ends at the same level.