title: Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy.
abstract: Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice. Recently, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective, even in patients with surgically altered anatomies. On the other hand, endoscopic partial stent-in-stent (PSIS) placement of self-expandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible, safe and effective. We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success. This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization, even in patients with surgically altered anatomies.
authors.affiliation: Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama 700-8558, Japan. tsutsumi@cc.okayama-u.ac.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomoda
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sakakihara
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Noma
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001659:Biliary Tract / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008670:Metals; D008875:Middle Aged; D009362:Neoplasm Metastasis; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals