Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jun 15;60(12):1871-1876.
doi: 10.2169/internalmedicine.6356-20. Epub 2021 Feb 1.

Hilar Malignant Biliary Obstruction Treated with Four Metallic Stents Involving a New Slim Device

Yuki Noguchi  1 , Mitsuru Sugimoto  1 , Yuichiro Kiko  2 , Tadayuki Takagi  1 , Rei Suzuki  1 , Naoki Konno  1 , Hiroyuki Asama  1 , Yuki Sato  1 , Hiroki Irie  1 , Jun Nakamura  1   3 , Mika Takasumi  1 , Minami Hashimoto  1   3 , Tsunetaka Kato  1   3 , Ryoichiro Kobashi  1 , Yuko Hashimoto  2 , Takuto Hikichi  3 , Hiromasa Ohira  1
Affiliations
Case Reports

Hilar Malignant Biliary Obstruction Treated with Four Metallic Stents Involving a New Slim Device

Yuki Noguchi et al. Intern Med. .

Abstract

Endoscopic hilar multiple stenting is challenging. A 68-year-old patient had self-expandable metallic stents (SEMSs) inserted for unresectable hilar malignant biliary obstruction. After the SEMSs were inserted into the left hepatic duct and bile duct branch of segment (B) 6, a new SEMS with a wide mesh and slim delivery system was inserted into the right anterior hepatic duct. However, liver abscess and dilated B7 were observed on computed tomography; therefore, an additional new SEMS was quickly and easily inserted into B7. After the placement of these four SEMSs, the liver abscess improved. The new SEMS was effective for hilar multiple biliary drainage.

Keywords: bilateral biliary drainage; hilar malignant biliary obstruction; self-expandable metallic stent.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Image findings and the diagnosis. A: A gallbladder tumor with common bile duct invasion was observed in contrast-enhanced CT (arrows). B: Common bile duct stricture was seen during ERC. A biliary ductal biopsy was performed. C: The biliary biopsy specimen was diagnosed as adenocarcinoma. Fibrosis was observed in the overall specimen. The tumor cells had irregular tubular structures and invasive proliferation. CT: computed tomography, ERC: endoscopic retrograde cholangiography
Figure 2.
Figure 2.
The state of biliary stricture and treatment. A: The hepatic ducts were divided into four branches (left, B6, B7, right anterior) by cancer. The black line represents the border between B7 and the right anterior hepatic duct. B: The Niti-S large cell stent D type 10 mm×10 cm (Taewoong Medical) was inserted in the left hepatic duct. The same stent (10 mm×8 cm) was inserted in B6. The new Niti-cell large cell stent with a slim delivery system (Taewoong Medical) was inserted into the right anterior hepatic duct. C: Approximately one week after the three SEMSs had been inserted, dilated B7 and a liver abscess (arrow) were observed on CT. D: ERC was performed, and the guidewire and ERC catheter were inserted in B7. E: Finally, four SEMSs were placed. F: Forty-three days after the four SEMSs had been inserted, improvement of the liver abscess was seen (arrow). All SEMSs were placed in a stent-in-stent fashion. B: The bile duct branch of the segment, SEMS: self-expandable metallic stent, CT: computed tomography, ERC: endoscopic retrograde cholangiography
Figure 3.
Figure 3.
The new SEMS with a slim delivery system. The Figures were supplied by Century Medical (Tokyo, Japan). A: The Niti-S large cell stent slim delivery (Taewoong Medical) with a 6-Fr delivery system. The delivery system of the conventional Niti-S large cell D type stent (Taewoong Medical) was 8 Fr. B: The 6-Fr delivery system has good trackability to the guidewire. C, D: At the tip of the 6-Fr delivery system, the step between the delivery system and guidewire becomes lower than that of the delivery system of the conventional 8-Fr delivery system. SEMS: self-expandable metallic stent
See this image and copyright information in PMC

References

    1. Kennedy TJ, Yopp A, Qin Y, et al. . Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB 11: 445-451, 2009. - PMC - PubMed
    1. Nuzzo G, Giuliante F, Ardito F, et al. . Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg 147: 26-34, 2012. - PubMed
    1. Wiggers JK, Groot Koerkamp B, Cieslak KP, et al. . Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg 223: 321-331 e321, 2016. - PMC - PubMed
    1. Takahashi Y, Nagino M, Nishio H, Ebata T, Igami T, Nimura Y. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg 97: 1860-1866, 2010. - PubMed
    1. Kawakami H, Kuwatani M, Onodera M, et al. . Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 46: 242-248, 2011. - PubMed

Publication types