Fishing line assisted endoscopic placement of multiple plastic biliary stents for unresectable malignant hilar biliary obstruction: a retrospective study

Background and aims Stent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication. Methods Patients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time. Results FLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05). Conclusions FLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

Efficacy of a Novel Large-cell Niti-S stent with a Slim Delivery System for Hilar Biliary Obstruction: A Preliminary Study

Background: The large-cell Niti-S stent is useful for multiple stenting in malignant hilar biliary obstruction (MHBO) patients. Recently, a novel uncovered self-expandable metallic stent (USEMS) (a large-cell Niti-S slim-delivery stent) was developed. In this study, we aimed to evaluate the efficacy of this slim-delivery USEMS in MHBO patients.Methods: Outcomes related to USEMS placement, clinical course, and patency period were evaluated in MHBO patients who received multiple USEMSs.Results: Fourteen MHBO patients underwent the placement of multiple USEMSs, including using the novel slim-delivery stent. Three patients had a past history of Billroth-II reconstruction. The number of USEMSs placed in each patient was 2-6. Three procedures were reinterventions. The new slim delivery system was used to place the first stent in three patients and an additional stent in the remaining patients. The technical and clinical success rates were both 100%. According to Kaplan-Meier analysis, the cumulative patency rate 50 days after USEMS placement was 87.5%.Conclusions: Placing multiple USEMSs in patients with a past history of abdominal surgery or in reintervention is difficult. The novel USEMS might overcome these difficulties and be the first choice for MHBO patients. TRIAL REGISTRATION: Not applicable