title: Dilatation by Soehendra stent retriever is feasible and effective in multiple deployment of metallic stents to malignant hilar biliary strictures.
abstract: OBJECTIVE
  The endoscopic management of malignant hilar biliary strictures using multiple metallic stents (MS) is technically demanding, in the initial deployment of MS and the recovery from MS occlusion with deployment of multiple plastic stents (PS). We evaluated the outcomes of the application of a Soehendra stent retriever (SSR) as a dilator of intractable strictures.
  
  
  METHODS
  Fifty-nine patients with malignant hilar biliary strictures had multiple MS inserted using a partial stent-in-stent procedure. When we encountered intractable strictures, we adopted SSR to dilate the stricture and the interstice of the MS. We evaluated the success rate of MS or PS deployment after SSR application and procedural complications.
  
  
  RESULTS
  Five of 59 patients (8%) were subjected to SSR application for the initial MS deployment. MS were successfully deployed in all of these patients (100%). MS occlusion was noted in 27 patients. We applied SSR to seven patients (26%) for the deployment of multiple PS after MS occlusion. In five patients (71%), successful PS deployment was achieved after the SSR application. No complications related to dilatation using SSR occurred in any patient.
  
  
  CONCLUSIONS
  SSR proved to be a potent dilator of difficult strictures in the management of malignant hilar biliary strictures.
authors.affiliation: Department of Gastroenterology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Noma
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Masakuni
authors.initials: M
authors.lastname: Fujii
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000150:complications*; D002779:Cholestasis / Q000628:therapy*; D004106:Dilatation; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents