Kamawaki Kouji, Ogura Takeshi, Ueno Saori, Okuda Atsushi, Nishioka Nobu, Sakamoto Jun, Hattori Nobuhiro, Nakamura Junichi, Bessho Kimi, Nishikawa Hiroki
Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Pancreatobiliary Advanced Medical Center, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan.
Therap Adv Gastroenterol. 2025 Jul 31;18:17562848251359410. doi: 10.1177/17562848251359410. eCollection 2025.
Malignant hilar biliary obstruction (MHBO) can be treated by stent deployment under endoscopic retrograde cholangiopancreatography. In case of unresectable MHBO, uncovered self-expandable metal stent (UCSEMS) deployment might be recommended. However, endoscopic revision is challenging. To overcome this issue, we previously described a novel revision technique called the "molting technique," but its technical feasibility is still unclear.
The present study aimed to evaluate the technical feasibility of the molting technique in a prospective setting.
A single-center prospective study.
Technical success was defined as successful endoscopic revision using the molting technique. If endoscopic revision using the molting technique in the hepatic bile duct failed on either side, the technique was considered a technical failure.
A total of 20 patients were prospectively enrolled in this study. The technical success rate was 90% (18/20). The mean procedure time was 20.6 ± 8.5 min, and clinical success was obtained in 94.4% of patients (17/18). The mean duration of stent patency after endoscopic revision was 118.2 days. Finally, adverse events were observed in three patients (pancreatitis, = 2, cholangitis, = 1), all of whom were successfully treated conservatively.
In conclusion, the molting technique might be helpful as an option for endoscopic revision for multiple UCSEMS deployments for selected patients.
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恶性肝门部胆管梗阻（MHBO）可通过内镜逆行胰胆管造影术放置支架进行治疗。对于不可切除的MHBO患者，可能会推荐使用未覆膜自膨式金属支架（UCSEMS）。然而，内镜下修复具有挑战性。为克服这一问题，我们之前描述了一种名为“蜕皮技术”的新型修复技术，但其技术可行性仍不明确。
本研究旨在评估蜕皮技术在前瞻性研究中的技术可行性。
单中心前瞻性研究。
技术成功定义为使用蜕皮技术进行内镜下成功修复。如果在肝内胆管两侧使用蜕皮技术进行内镜下修复失败，则该技术被视为技术失败。
本研究前瞻性纳入了20例患者。技术成功率为90%（18/20）。平均手术时间为20.6±8.5分钟，94.4%的患者（17/18）获得临床成功。内镜下修复后支架通畅的平均持续时间为118.2天。最后，3例患者出现不良事件（胰腺炎，2例；胆管炎，1例），所有患者均经保守治疗成功。
总之，对于部分患者，蜕皮技术可能是多次UCSEMS放置后内镜下修复的一种有用选择。
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