Simultaneous Versus Sequential Side-by-Side Bilateral Metal Stent Placement for Malignant Hilar Biliary Obstructions
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Endoscopic bilateral self-expandable metallic stent (SEMS) placement for malignant hilar biliary obstructions (MHBOs) is technically demanding, and a second SEMS insertion is particularly challenging. A simultaneous side-by-side (SBS) placement technique using a thinner delivery system may mitigate these issues.
We aimed to examine the feasibility and efficacy of simultaneous SBS SEMS placement for treating MHBOs using a novel SEMS that has a 5.7-Fr ultra-thin delivery system.
Thirty-four patients with MHBOs underwent SBS SEMS placement between 2010 and 2016. We divided the patient cohort into those who underwent sequential (conventional) SBS placement between 2010 and 2014 (sequential group) and those who underwent simultaneous SBS placement between 2015 and 2016 (simultaneous group), and compared the groups with respect to the clinical outcomes.
The technical success rates were 71% (12/17) and 100% (17/17) in the sequential and simultaneous groups, respectively, a difference that was significant (P = .045). The median procedure time was significantly shorter in the simultaneous group (22 min) than in the sequential group (52 min) (P = .017). There were no significant group differences in the time to recurrent biliary obstruction (sequential group: 113 days; simultaneous group: 140 days) or other adverse event rates (sequential group: 12%; simultaneous group: 12%).
Simultaneous SBS placement using the novel 5.7-Fr SEMS delivery system may be more straightforward and have a higher success rate compared to that with sequential SBS placement. This new method may be useful for bilateral stenting to treat MHBOs.
KeywordsSelf-expandable metallic stent Bilateral drainage Malignant hilar biliary obstruction Side-by-side placement
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
Sequential side-by-side placement of self-expandable metallic stents for high-grade malignant hilar biliary obstruction. After inserting 2 guidewires into the left and right intrahepatic bile ducts, the first stent was inserted and placed in the right hepatic duct. Next, the second stent was inserted and placed in the left hepatic duct alongside the first stent over the other guidewire. (MPG 33610 kb)
Simultaneous side-by-side self-expandable metallic stent placement for high-grade malignant hilar biliary obstruction. After inserting 2 guidewires into the left and right intrahepatic bile ducts, 2 5.7-Fr delivery systems were simultaneously inserted over each guidewire through the duodenoscope’s 4.2-mm working channel. Next, 2 stents were simultaneously placed in a side-by-side configuration, aligning the distal stent ends above the duodenal papilla. (MPG 41932 kb)
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