title: Use of a temporary plastic stent to facilitate the placement of multiple self-expanding metal stents in malignant biliary hilar strictures.
abstract: BACKGROUND
  Although endoscopic palliation of malignant biliary hilar obstruction is preferable to surgery or percutaneous drainage, it remains technically challenging. This is especially true when multiple self-expanding metal stents (SEMS) are placed, because difficulty is commonly encountered in passing the second SEMS at the level of the previously deployed initial stent. We have devised a method of deploying multiple metal stents by using a temporary plastic stent, which makes deployment of the second stent much easier.
  
  
  METHODS
  After guidewire placement, a plastic stent is deployed in a subhilar position. The initial SEMS is deployed, with the plastic stent maintaining a passage for the second SEMS. After the second SEMS is deployed, the plastic stent is retrieved.
  
  
  METHODS
  This technique has been used successfully in 7/8 patients, all of whom presented with symptomatic jaundice secondary to malignant hilar obstruction of various etiologies (cholangiocarcinoma, n=4; metastatic disease, n=3; and hepatocellular carcinoma, n=1). Drainage was successful in all cases, with significant improvement in symptoms and cholestasis.
  
  
  CONCLUSIONS
  This simple technique lessens the technical difficulty of placing bilateral hilar SEMS.
authors.affiliation: Department of Gastroenterology, Erasmus University Hospital, Brussels, Belgium.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Hookey
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Moine
authors.forename: Jacques
authors.initials: J
authors.lastname: Deviere
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications; D001943:Breast Neoplasms / Q000150:complications / Q000556:secondary; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008670:Metals; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010969:Plastics; D011471:Prostatic Neoplasms / Q000150:complications / Q000556:secondary; D019919:Prosthesis Implantation / Q000295:instrumentation*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010969:Plastics