A self-expandable metallic stent in combination with cholangioscopic microwave coagulation therapy and chemotherapy with oral TS-1 against obstructive jaundice due to recurrent gastric cancer: a case report of successful treatment.

Obstructive jaundice is a terminal symptom of gastric cancer. A 45-year-old female patient had a recurrent gastric cancer at the pancreas head and it caused obstructive jaundice. She was treated with percutaneous transhepatic cholangio-drainage, followed by radiotherapy and chemotherapy with cisplatin, epirubicin and 5-FU, which resulted in a prominent response and a self-expandable metallic stent was placed into the bile duct. After 11 months, however, the tumor recurred and the bile duct was obstructed again by an invading tumor. She was retreated with percutaneous transhepatic cholangio-drainage for jaundice, followed by chemotherapy with oral TS-1. Her recurrent tumor dramatically responded again, and cholangioscopic microwave coagulation therapy was applied for the first time through a cholangio-drainage route and an additional metallic stent was inserted into the bile duct. After these therapies she has been disease--free for more than 2 years. In conclusion, the placement of a self-expandable metallic stent in combination with cholangioscopic microwave coagulation therapy and TS-1 was very effective in managing the obstructive jaundice due to the local recurrence of gastric cancer.