Simultaneous Side-by-Side Bilateral Placement of Braided-Type Metal Stents Using a 5.9F Delivery System for Unresectable Malignant Hilar Biliary Obstruction: A Preliminary Feasibility Study.

Side-by-side (SBS) bilateral placement of self-expandable metal stents (SEMSs) is limited by technical difficulties in cases of malignant hilar bile duct obstruction (MHBO). Recently, a braided SEMS with a 5.9 F ultra-thin introducer was developed that enables simultaneous bilateral stenting. This preliminary study was undertaken to determine the feasibility, safety, and effectiveness of SBS simultaneous bilateral stenting using braided SEMSs and a 5.9 F introducer for MHBO management. We reviewed 8 patients of medical reports who were performed simultaneous SBS placement of SEMSs due to MHBO between January 2016 and January 2018. Both of technical and clinical success rates were 100% (8/8), and success rate of stent distal end alignment was also 100%. None of early procedure-related adverse events were detected in 30 days after the stent insertion. Median duration of stent patency was 300 days (95% Cl, 280-726.9), and median survival was 229 days (range, 128-728). Simultaneous SBS stent placement using novel braided metal stents was found to be feasible in patients with MHBO. Prospective well-designed clinical studies are needed to certify the efficacy of the stenting technique for MHBO.