| Abstract: | Endoscopic insertion of self-expandable metallic stents is considered to be safer and less invasive than percutaneous stenting for patients with malignant biliary strictures. However, the technique of implantation of multiple self-expandable metallic stents by endosocpic means has not yet been fully established. We evaluated the technical feasibility of endoscopic negotiation of bilateral hepatic ducts with subsequent placement of multiple self-expandable metallic stents in parallel. Bilateral hepatic ducts were negotiated with guidewires, and self-expandable metallic stents were sequentially introduced and deployed over the prepositioned guidewires in seven patients with irre-sectable malignant hilar strictures. Insertion and deployment of self-expandable metallic stents into both the right and left hepatic ducts were successful in six of the seven patients. The remaining patient was eventually treated with bilateral hepatic drainage using two wallstents; one was inserted endoscopically and the other percutaneously. The patients were followed up for 36–349 days (mean; 227). In two patients, stent occlusion due to sludge formation occurred 119 and 178 days after the treatment. However, endoscopic reintervention was easily performed with a favorable clinical outcome in both patients. Endoscopic bilateral hepatic drainage of multiple, self-expandable metallic stents in parallel is considered to be a simple, safe, and reliable for irresectable malignant hilar stricture. (Dig Endosc 1999; 11: 225–230) |
