Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2019; 7(11): 1323-1329
Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1323
Development of a biliary multi-hole self-expandable metallic stent for bile tract diseases: A case report
Makoto Kobayashi
Makoto Kobayashi, Division of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Mie 5108657, Japan
Author contributions: Kobayashi M designed and performed the research, analyzed the data and wrote the paper.
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: Kobayashi M has a patent on the multi-hole self-expandable metallic stent with royalties paid by M.I.Tech Co., Ltd.
CARE Checklist (2016) statement: The authors have read the CARE 2016 Checklist, and the manuscript was prepared and revised according to the CARE 2016 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Makoto Kobayashi, MD, PhD, Doctor, Division of Gastroenterology, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, Mie 5108657, Japan. makoto-kobayashi@aroma.ocn.ne.jp
Telephone: +81-593-541111 Fax: +81-59-3521565
Received: October 31, 2018
Peer-review started: October 31, 2018
First decision: December 5, 2018
Revised: April 20, 2019
Accepted: May 11, 2019
Article in press: May 11, 2019
Published online: June 6, 2019
Processing time: 219 Days and 12.8 Hours
Abstract
BACKGROUND

Uncovered stents used for malignant obstructions in the biliary tree, especially in the hilar area, are prone to obstruction by tumor ingrowths. In comparison, however, covered stents may block bile duct branches and are at risk of migration. We have developed a multi-hole self-expandable metallic stent (MHSEMS), with a hole in each cell, to prevent the obstruction of bile duct branches. In addition, the holes may prevent migration due to small ingrowths by reducing the tension of the membrane.

CASE SUMMARY

MHSEMS were placed in five patients with a malignant obstruction and one with post-endoscopic sphincterotomy bleeding. Each MHSEMS was successfully deployed in all cases. Patients showed no complications. Two cases were reviewed. Case 1: A 74-year-old male presented with jaundice and was diagnosed with a sigmoid colon cancer and giant liver metastases in the right liver lobe. A MHSEMS was placed in the left bile duct. The jaundice improved and peroral cholangioscopy was performed. Case 2: A 90-year-old female was admitted to hospital for jaundice and diagnosed with cholangiocarcinoma. A MHSEMS was placed in the left bile duct but after 8 months the stent became obstructed by tumor ingrowth. We treated the patient by ablation therapy. A silicone cover separated the internal bile duct from the surrounding tissue, protecting the latter from thermal injury during treatment by endobiliary ablation of the re-obstruction.

CONCLUSION

A MHSEMS is a new choice of stent for biliary tract diseases.

Keywords: Multi-hole self-expandable metallic stent; Malignant biliary stricture; Benign biliary stricture; Hilar biliary obstruction; Distal biliary obstruction; Endobiliary radiofrequency ablation; Case report

Core tip: We have developed a multi-hole self-expandable metallic stent (MHSEMS), with a hole in each cell, to prevent the obstruction of bile duct branches. In addition, the holes prevent migration due to small ingrowths by reducing the tension of the membrane. MHSEMS were placed in six patients. Each MHSEMS was successfully deployed with no complications in all cases. An ingrowth case was treated by electrical ablation therapy. Two cases were reviewed. We concluded that a MHSEMS is a new choice of stent for biliary tract diseases.