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CC BY 4.0 · Endoscopy 2025; 57(S 01): E312-E313
DOI: 10.1055/a-2569-7582
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Side-by-side placement of a novel slim 6-mm multi-hole covered self-expandable metallic stent for malignant hilar biliary obstruction

Sho Takahashi
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
,
Toshio Fujisawa 
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
,
Yusuke Takasaki
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
,
Daisuke Namima
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
,
Ko Tomishima
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
,
Shigeto Ishii
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
,
Hiroyuki Isayama 
1   Department of Gastroenterology, Jutendo University, Graduate School of Medicine, Tokyo, Japan
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The drainage method for malignant hilar biliary obstruction (MHBO) has not been established. A 6-mm slim fully covered self-expandable metallic stent (FCSEMS) prevents tumor ingrowth and can be exchanged, but it carries the risk of segmental cholangitis by blocking the side branches of the bile duct [1]. A novel slim multi-hole FCSEMS (slim-MHSEMS) could resolve this issue [2] [3] [4].

A 60-year-old man with pancreatic head cancer presented with Bismuth type IIIb MHBO ([Fig. 1]). Bilateral stenting was performed using the slim-MHSEMS (HANARO Biliary Multi-hole Benefit; M.I. Tech Co., Ltd., Pyeongtaek, South Korea), which has six 1.6-mm holes evenly spaced along its circumference ([Fig. 2]). The diameter of the delivery system of the slim-MHSEMS was 5.9-Fr, and simultaneous deployment was possible. Two slim-MHSEMSs (6 mm in diameter and 12 cm in length) were deployed simultaneously in side-by-side placement across the papilla ([Video 1]). The tip of one slim-MHSEMS was placed in the B2 branch, and the contrast medium remained in B3 and B4 ([Fig. 3]). However, it disappeared on an X-ray image taken the next day. Furthermore, the X-ray image revealed the pneumobilia of B4 ([Fig. 4]).

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Fig. 1 A fluoroscopic image presenting Bismuth type IIIb malignant hilar biliary obstruction.
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Fig. 2 Enlarged image of the tip of the slim multi-hole self-expandable metallic stent (MHSEMS). It has six 1.6-mm holes evenly spaced along its circumference.

Quality:
Two slim MHSEMSs (6 mm in diameter and 12 cm in length) were deployed simultaneously in side-by-side placement.Video 1

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Fig. 3 Slim-MHSEMSs were simultaneously deployed using side-by-side method. Yellow arrows: the proximal end of a slim MHSEMS in the B2 and B5 branches.
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Fig. 4 An X-ray image taken the next day reveals the disappearance of the contrast agent. Yellow arrows: pneumobilia in the B4 branch.

A fully covered SEMS has not been placed for MHBO due to the risk of segmental cholangitis. Because of the holes and diameter of the SEMS, the slim-MHSEMS can be safely and effectively placed for MHBO without obstructing the bile duct branches. Furthermore, simultaneous side-by-side placement of slim-MHSEMSs was easier than the previous bilateral stenting procedure. This report presents the first case of simultaneous side-by-side placement of slim-MHSEMSs for MHBO.

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Publication History

Article published online:
15 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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