Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1323
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
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.
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.
A MHSEMS is a new choice of stent for biliary tract diseases.
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.