Novel endoscopic technique for tri-segment drainage in patients with unresectable hilar malignant biliary strictures (with video).

Abstract Background and Aims Three or more stents may be needed in patients with extensive stricturing in Bismuth type IIIa/IV hilar malignant strictures. Partial stent-in-stent (PSIS) deployment has been the primary intervention for hilar malignant biliary stricture (MBS). However, simultaneous side-by-side stent placement (SBS) has become feasible with the development of the Methods This study included 17 consecutive patients with Bismuth IIIa or IV malignant strictures who underwent endoscopic drainage using the hybrid method. The diameters of the delivery stents were 5.4F (n=10) and 5.7F (n=7). Results The technical success rate was 82% (14/17), and the median length of procedures was 54 minutes. Two patients required predilatation for deployment of the third SEMS through the mesh of the first deployed stent. Two patients (12%) developed cholecystitis as early adverse events and one patient (6%) developed liver abscess as a late adverse event. The time to recurrent biliary obstruction among those with successful initial tri-segmental drainage was 189 days (95% confidence interval [CI], 124–254 days). Conclusions The hybrid method for unresectable hilar MBS is an effective endoscopic drainage method, and the ease of these procedures is partly attributed to the thinner stent delivery system.