Covered self-expandable metal stents (cSEMS) are commonly used to treat malignant
distal biliary obstruction (MDBO) [1]; however, they can lead to cholecystitis [2]
[3]. A novel stent – the HILZO dumbbell-shaped stent with spiral cover (ABIS Inc., Hyogo,
Japan) was designed to prevent stent-related cholecystitis [4]. The dumbbell-shaped proximal end creates space around the orifice of the cystic
duct (OCD), while the spiral outer cover facilitates bile flow ([Fig. 1], [Fig. 2]). Herein, we report two cases of MDBO in which the novel cSEMS was placed beyond
the OCD ([Video 1]).
Fig. 1 A novel HILZO dumbbell-shaped stent with spiral cover (ABIS Inc., Hyogo, Japan) is
designed to prevent stent-related cholecystitis.
Fig. 2 The spiral outer cover allows bile to flow out through the gaps (arrows).
The novel HILZO dumbbell-shaped stent with spiral cover (ABIS Inc., Hyogo, Japan)
can prevent stent-related cholecystitis in patients with malignant distal biliary
obstruction.Video 1
Case 1: A 62-year-old woman with MDBO secondary to pancreatic cancer was referred
to our hospital. Endoscopic retrograde cholangiopancreatography was performed due
to recurrent biliary obstruction after initial cSEMS placement. Cholangiography revealed
the OCD above the biliary stricture. The novel cSEMS (8 mm, 7 cm) was deployed to
cover the OCD with the covered part of the stent. Although contrast medium pooled
in the cystic duct during the procedure, it flowed out and was replaced by air immediately
after cSEMS placement ([Fig. 3]). The patient was discharged without complications.
Fig. 3 Case 1. a Cholangiography revealed the orifice of the cystic duct (arrows) above the stricture.
b The novel HILZO stent (ABIS Inc., Hyogo, Japan) was deployed from the common hepatic
duct to the duodenum. c Contrast agent that had pooled in the cystic duct flowed out after stent placement.
Case 2: An 80-year-old woman with MDBO due to pancreatic cancer was admitted to our
hospital. Cholangiography revealed the OCD at the proximal end of the biliary stricture.
Initially, transpapillary gallbladder drainage was attempted to prevent stent-related
cholecystitis; however, a guidewire could not be advanced into the gallbladder due
to the highly angulated cystic duct. Therefore, the novel cSEMS (8 mm, 7 cm) was placed
beyond the OCD. Stent deployment was successfully performed from the common hepatic
duct to the duodenum ([Fig. 4]). The patient was discharged without any complications, and follow-up computed tomography
showed a collapsed gallbladder compared with before cSEMS placement ([Fig. 5]).
Fig. 4 Case 2. a Cholangiography revealed the orifice of the cystic duct at the proximal end of the
biliary stricture. b The novel HILZO stent (ABIS Inc., Hyogo, Japan) was successfully placed.
Fig. 5 Case 2: Computed tomography showed the gallbladder collapse compared with before placement
of the novel HILZO stent (ABIS Inc., Hyogo, Japan). a Before stent placement. b After stent placement.
To the best of our knowledge, this is the first report of a novel HILZO stent used
to prevent stent-related cholecystitis in patients with MDBO.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
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