In view of the recent advancement in endoscopic devices for biliary endoscopic intervention,
the expert endoscopist can address complex morbidity. However, endoscopic 3-branched
partial stent-in-stent deployment of metallic stents (MS) in patients with malignant
hilar biliary stricture is technically demanding.
To evaluate the efficacy and safety of endoscopic 3-branched partial stent-in-stent
deployment of MS.
Case study.
Gastroenterological Center, Okayama University Hospital.
Nine consecutive patients (mean age 63 years, range 52-84 years, mean follow-up period
5 months) with malignant hilar biliary stricture were enrolled. They had cytologically
or histologically proven unresectable biliary-tract carcinoma with hilar biliary stricture
type IIIa or IV according to Bismuth's classification.
Endoscopic 3-branched partial stent-in-stent deployment of MS in hilar biliary strictures
by using a JOSTENT SelfX stent.
The success rate of the procedure, stent patency time, reinterventions, and complications.
Endoscopic 3-branched partial stent-in-stent deployment was successfully accomplished
in all cases. The MS became obstructed in 3 cases (33%), mean 1.5 months, range 1.4
to 2.7 months. However, no MS obstruction occurred in the other 6 patients (67%),
mean 11 months, range 4.7 to 16.4 months. In the obstructed cases, the deployment
of 2 or 3 tube stents was completed successfully. One case of cholecystitis was observed
as a short-term complication.
The small number of cases.
Endoscopic 3-branched partial stent-in-stent deployment of a JOSTENT SelfX stent was
effective in selected patients with high-grade malignant hilar biliary stricture.