One-Stage Percutaneous Self-Expandable Metal Stent Placement for Malignant Biliary Obstruction: A Five-Case Series.
Endoscopic retrograde cholangiopancreatography (ERCP) with self-expandable metal stent (SEMS) placement is the standard treatment for malignant biliary obstruction; however, it may not be feasible in cases of duodenal invasion, altered anatomy, or failed cannulation. Although percutaneous transhepatic biliary drainage is a reliable alternative, it is associated with external catheter-related complications and impaired quality of life. Recently, a one-stage percutaneous SEMS placement procedure has been proposed to overcome these limitations.
We retrospectively reviewed five patients (four women and one man; median age, 68 years) with malignant biliary obstruction who underwent one-stage percutaneous SEMS placement between April 2016 and March 2025 at the Tokai University Hospital. The procedures were performed under ultrasonographic guidance using a 19-gauge EVS™ needle, followed by guidewire exchange, tract dilation with an 8-Fr dilator, and deployment of an Epic™ biliary SEMS. Technical and clinical success and procedure-related complications were evaluated.
Herein, the underlying diseases included pancreatic head carcinoma (n = 1), postoperative cholangiocarcinoma with lymph node recurrence (n = 2), postoperative gallbladder carcinoma with lymph node recurrence (n = 1), and postoperative gastric carcinoma with peritoneal dissemination (n = 1). ERCP failure was due to the following reasons: duodenal stenosis, choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with cannulation failure, laparoscopic SSPPD not attempted due to inflammation, and Roux-en-Y reconstruction. Three and two patients presented with moderate and mild cholangitis, respectively, as per the Tokyo Guidelines 2018. Technical success was achieved in all patients. No procedure-related complications occurred.
One-stage percutaneous SEMS placement is a safe and effective option for treating malignant biliary obstruction in patients unsuitable for ERCP or endoscopic ultrasound-guided biliary drainage. With careful case selection, this approach enables rapid biliary decompression without external drainage and may improve the patient's quality of life.
We retrospectively reviewed five patients (four women and one man; median age, 68 years) with malignant biliary obstruction who underwent one-stage percutaneous SEMS placement between April 2016 and March 2025 at the Tokai University Hospital. The procedures were performed under ultrasonographic guidance using a 19-gauge EVS™ needle, followed by guidewire exchange, tract dilation with an 8-Fr dilator, and deployment of an Epic™ biliary SEMS. Technical and clinical success and procedure-related complications were evaluated.
Herein, the underlying diseases included pancreatic head carcinoma (n = 1), postoperative cholangiocarcinoma with lymph node recurrence (n = 2), postoperative gallbladder carcinoma with lymph node recurrence (n = 1), and postoperative gastric carcinoma with peritoneal dissemination (n = 1). ERCP failure was due to the following reasons: duodenal stenosis, choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with cannulation failure, laparoscopic SSPPD not attempted due to inflammation, and Roux-en-Y reconstruction. Three and two patients presented with moderate and mild cholangitis, respectively, as per the Tokyo Guidelines 2018. Technical success was achieved in all patients. No procedure-related complications occurred.
One-stage percutaneous SEMS placement is a safe and effective option for treating malignant biliary obstruction in patients unsuitable for ERCP or endoscopic ultrasound-guided biliary drainage. With careful case selection, this approach enables rapid biliary decompression without external drainage and may improve the patient's quality of life.
Authors
Izumi Izumi, Kaneko Kaneko, Ogasawara Ogasawara, Mukai Mukai, Makuuchi Makuuchi
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