Prospective evaluation study of a novel endoscopic revision technique after metal stent deployment for hepatic hilar obstruction.

BACKGROUND

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.

OBJECTIVE

The present study aimed to evaluate the technical feasibility of the molting technique in a prospective setting.

DESIGN

A single-center prospective study.

METHODS

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.

RESULTS

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, n = 2, cholangitis, n = 1), all of whom were successfully treated conservatively.

CONCLUSION

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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