A malignant hilar biliary stricture is usually unresectable at the
time of diagnosis and requires multiple biliary stentings. Metallic mesh stents
remain patent for a relatively long time in the biliary stricture compared to
tube stents [1]. However, employing multiple metallic
mesh stents is sometimes very difficult because of their small lumen, which
impedes the delivery of a catheter. The Soehendra stent retriever (Soehendra
SR; Wilson-Cook Medical Inc., Winston-Salem, North Carolina, USA) is useful for
dilating a stenosed biliary or pancreatic duct [2]
[3]
[4]. We used it to expand the mesh
holes in metallic mesh stents placed in patients with malignant biliary hilar
stricture who were undergoing multiple stenting.
We used the retriever in three patients with unresectable hilar
biliary carcinoma. [Fig. 1]
a shows the endoscopic cholangiogram of a patient with a
Bismuth type III stricture. A guide wire was negotiated into the right biliary
tree and a metallic mesh stent inserted (JoStent SelfX stent; Abbott Vascular
Devices, Redwood City, California, USA) ([Fig. 1]
b). Then, a second
guide wire was negotiated into the left biliary tree through a mesh hole in the
first stent. Despite several attempts using dilation catheters, it was not
possible to insert them into the left biliary tree because of the small mesh
holes of the stents. We therefore introduced a Soehendra SR and advanced it
along the guide wire, turning it clockwise to allow the threads at the end of
the device to engage the mesh and expand the stent hole ([Fig. 2 ]
a). After
expansion, a metallic mesh stent delivery catheter was easily introduced into
the biliary tree ([Fig. 2 ]
b) and multiple stenting was achieved ([Fig. 2 ]
c). We
successfully carried out multiple stenting using metallic mesh stents in two
other patients and no relevant complications were encountered. Our results
indicate that the Soehendra SR was useful in expanding the mesh holes of a
metallic stent in patients requiring multiple stenting with metallic mesh
stents.
Fig. 1 a Cholangiogram showing a
Bismuth type III hilar stricture. b A metallic mesh
stent was placed in the right biliary tree.
Fig. 2 a A Soehendra stent retriever
was advanced along the guide wire to expand the mesh holes of the first
metallic mesh stent. b A metallic mesh stent delivery
catheter was then easily introduced into the left biliary tree.
c Multiple stenting was successfully accomplished.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
