Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients

Controversy exists over the need for unilateral versus bilateral stent placement in patients withmalignant obstruction at the biliary hilum. Placement of bilateral uncovered self-expanding metal stent(UCSEMS) at this location is technically challenging, and generally associated with lower rates of proceduralsuccess. Serial insertion of side-by-side UCSEMS may be especially difficult when simultaneous deploymentis not possible using larger stent delivery catheters. In this single-center, retrospective case series of allpatients who underwent bilateral placement of uncovered WallflexTM biliary stents between July 2008 andJuly 2014, we evaluate the feasibility, technical success, and safety of patients undergoing serial insertionof bilateral UCSEMS using the 8 Fr WallflexTM biliary system for malignant hilar obstruction. A totalof 17 patients were included. Primary cholangiocarcinoma, Bismuth IV, was the most common diagnosis.Mean procedure time was 54.4 minutes. Overall procedural technical success was achieved in 17/17 patients.Stricture dilation was necessary prior to WallflexTM insertion in 8/17 patients (47.1%). Transpapillaryextension of two stents was performed in all patients. There were no cases of stent deployment malfunction,or inability to insert or deploy the 2nd stent. Nine of 17 patients (52.9%) required inpatient hospitalizationfollowing ERCP; the most common indications were abdominal pain and need for IV antibiotics. There wasone case of ERCP-related cholangitis otherwise; there were no other major complications. Bilateral, serialinsertion of UCSEMS using the 8 Fr WallflexTM biliary system in malignant hilar obstruction is feasible withan excellent technical success profile. Using this device for side-by-side deployment of UCSEMS appears tobe safe in the majority of patients.