Endoscopic bilateral stenting of malignant hilar bile duct obstruction using novel partially covered self-expandable metal stents

Abstract

Endoscopic bilateral stenting using conventional metal stents is considered to be technically difficult in patients with malignant hilar bile duct obstruction because the second stent is not easily inserted through the cell of the first stent wall in the bile duct [1]. A variety of new self-expandable metal stents (SEMS) specially designed for stent-in-stent procedures to facilitate bilateral stents deployment have been recently reported [1] [2] [3] [4] [5]. We report two cases of malignant hilar bile duct obstruction which were managed by endoscopic bilateral stenting using novel metal stents (KEY stents; S&G BioTech Inc., Seongnam, Korea). These stents are self-expanding Nitinol stents partially covered with a silicone membrane and consisting of a body stent (first stent) and a limb stent (second stent). The body stent is composed of a body and two legs: a long leg and a short leg. The short leg facilitates insertion of a guide wire into the contralateral intrahepatic bile duct (IHD) for the limb stent ([Fig. 1]). After placement of the body stent to one side of both IHDs across the hilar stricture, the limb stent is introduced into another IHD through the short leg of the body stent ([Fig. 2]).