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DOI: 10.1055/a-2512-5264
Slip-knot thread method for performing anchor-wire technique to prevent proximal dislocation of preceding stent in placement of multiple biliary inside plastic stents
Endoscopic biliary drainage using “inside plastic stents” (iPSs) is favored for patients with unresectable malignant hilar obstruction, because it offers prolonged stent patency and easy reintervention [1]. However, one of the problems encountered in the endoscopic placement of multiple iPSs is proximal dislocation of the preceding iPS during the subsequent iPS insertions. Although several methods for preventing preceding iPS migration have been reported [2] [3], some devices are not immediately available. Herein, we report a case in which a slip-knot was created using the threads of the preceding iPS ([Fig. 1]), to to perform the anchor-wire technique [4] for preventing its proximal dislocation during the endoscopic placement of the subsequent iPS.


A 72-year-old man with malignant hilar obstruction due to gallbladder cancer was admitted to our institution for acute cholangitis associated with recurrent biliary obstruction ([Fig. 2]). Endoscopic retrograde cholangiopancreatography was performed, and the initial iPS (Through & Pass IS; Gadelius Medical, Tokyo, Japan) was removed. Although bilateral drainage using iPSs was necessary, proximal dislocation of the preceding iPS was anticipated because the biliary stenosis was severe. Therefore, a slip-knot was created in the threads of the first iPS, before it was inserted. Because the preceding iPS was almost dislocated proximally during the subsequent iPS insertion, anchor-wire technique was performed using the thread’s loop formed with slip-knot [4]. Following this, the subsequent iPS was successfully inserted into the intrahepatic bile duct through the hilar obstruction without dislocation of the preceding iPS and placed in the appropriate position. After placement of the iPSs, the slip-knot threads were straightened by pulling the end with a biopsy forceps passed through the working channel of the duodenoscope ([Fig. 3], [Video 1]). This procedure requires only commonly used biopsy forceps additionally and is easy to do.




Qualität:
The slip-knot thread method for performing the anchor-wire technique is useful for preventing proximal dislocation of the preceding iPS during the endoscopic placement of multiple iPSs.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Kanno Y, Ito K, Nakahara K. et al. Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial. Gastrointest Endosc 2023; 98: 211-221
- 2 Mandai K, Nakamura S. Securing threads with a novel clip to prevent preceding stent migration in multiple biliary inside plastic stents. Dig Endosc 2024; 36: 508-509
- 3 Ban T, Kubota Y, Takahama T. et al. Two-devices-in-one-channel method for preventing the preceding stent migration in case of multiple indwelling biliary inside plastic stents. Endoscopy 2022; 54: E948-E949
- 4 Hamada T, Nakai Y, Matsubara S. et al. Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation. World J Gastroenterol 2011; 17: 3366-3368
Correspondence
Publikationsverlauf
Artikel online veröffentlicht:
23. Januar 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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References
- 1 Kanno Y, Ito K, Nakahara K. et al. Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial. Gastrointest Endosc 2023; 98: 211-221
- 2 Mandai K, Nakamura S. Securing threads with a novel clip to prevent preceding stent migration in multiple biliary inside plastic stents. Dig Endosc 2024; 36: 508-509
- 3 Ban T, Kubota Y, Takahama T. et al. Two-devices-in-one-channel method for preventing the preceding stent migration in case of multiple indwelling biliary inside plastic stents. Endoscopy 2022; 54: E948-E949
- 4 Hamada T, Nakai Y, Matsubara S. et al. Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation. World J Gastroenterol 2011; 17: 3366-3368





