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Background: After multiple uncovered self-expandable metal stent (UCSEMS) deployments, endoscopic revision becomes complex and potentially challenging. A novel stent delivery system with a dilation function has recently been developed in Japan. This study evaluated the technical feasibility of this device for patients with unresectable malignant hilar biliary obstruction (MHO) after multiple UCSEMS deployments. Method: Participants comprised consecutive patients with unresectable MHO who had undergone multiple UCSEMS deployments and required endoscopic revision for the right or left hepatic bile ducts, as decided by cholangiography under endoscopic retrograde cholangiopancreatography (ERCP) guidance. Results: A total of 14 patients requiring endoscopic revision of right and left hepatic bile ducts were enrolled in this study. Among these 14 patients, guidewire insertion through the mesh of previously placed stents failed in 2 patients. As a result, these two patients underwent only unilateral UCSEMS deployment. Because clinical success was not obtained, transmural placement of the UCSEMS under Endoscopic Ultrasound (EUS) guidance to the segment of the liver not being drained was performed in those patients. The molting technique was attempted in 12 patients, proving successful in all patients. The technical success rate was therefore 92.8% (12/14). Mean procedure time was 23.2 min. Conclusion: This novel stent delivery system with a dilation function may be useful in endoscopic revision techniques for bilateral UCSEMS deployment. [ABSTRACT FROM AUTHOR]

A prerequisite for endoscopic ultrasound (EUS)‐guided hepaticogastrostomy (HGS) is adequate dilation of the intrahepatic bile duct. Compared with a 19G needle, the 22G needle offers more flexible manipulation and superior ability to achieve bile duct puncture. However, evidence regarding EUS‐HGS using a 22G needle remains limited. The present study evaluated the feasibility and safety of EUS‐HGS using a novel 0.018‐inch guidewire and 22G needle for patients with insufficient intrahepatic bile duct dilation. If the bile duct diameter was <1.5 mm, a 22G needle was used, and the diameter was ≥1.5 mm; puncture with a 19G needle was first attempted, with the 22G needle being inserted if initial bile duct puncture failed. EUS‐HGS using the 22G needle was attempted in a total of 10 patients, including one patient with failed insertion of a 19G needle. Median diameter of the puncture site was 1.2 mm (range 0.5–2.5 mm). Bile duct puncture using the 22G needle was successful in all patients. Insertion of the novel 0.018‐inch guidewire was also successful in all patients. However, since tract dilation using an ultra‐tapered mechanical dilator failed in two patients, tract dilation was performed using a balloon dilator. Finally, stent deployment was successfully performed in all patients. EUS‐HGS using a 22G needle with a novel 0.018‐inch guidewire appears safe and feasible. [ABSTRACT FROM AUTHOR]

A cholangioscope inserted before intraductal RFA to prevent bile duct perforation revealed a tumor in the bile duct (Fig. 3 Cholangiography views. a The dilated bile duct after radiofrequency ablation. b Deployment of multiple uncovered self-expandable metal stents was easily achieved using the stent-in-stent technique. 2018, 15, 722 - 727 4 Chahal P., Baron T. H. Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction. [Extracted from the article]

The article presents a case study of a 82-year-old woman with hepatic hilar carcinoma who had been treated using several metal stents 6 months previously was admitted with obstructive jaundice. It discusses that computed tomography imaging indicated stent obstruction and the endoscopic retrograde cholangiopancreatography showed obstruction in the hepatic bile ducts and subsequent treatment provided to the patient.