Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer

Figure 1 Patient flowchart. MH-SEMS: Multi-hole self-expandable metallic stent; MDBO: Malignant distal biliary obstruction; NACRT: Neoadjuvant chemoradiotherapy; PC: Pancreatic cancer; RBO: Recurrent biliary obstruction; TNT: Total neoadjuvant therapy.

Figure 2 Multi-hole self-expandable metallic stent. Six rows of side holes were drilled on the membrane, aligning with the longitudinal direction of the stent (orange circles). Each side hole had a diameter of 1.8 mm.

Figure 3 Endoscopic findings and resected specimens. A: The endoscopic image. A multi-hole self-expandable metallic stent (MH-SEMS) was inserted in a patient with malignant distal biliary obstruction caused by borderline resectable pancreatic cancer with portal vein invasion; B: The fluoroscopic image of MH-SEMS; C: After surgery (pancreatoduodenectomy with portal vein resection), the stent was easily removed from the surgical specimen. The yellow arrow points to the Papilla of Vater after stent removal; D: The resected specimen was diagnosed appropriately without being affected by stent removal. The yellow arrowheads denote the common bile duct after stent removal.