title: A Case Series: Outcomes of Endoscopic Biliary Self-Expandable Metal Stent for Malignant Biliary Obstruction with Surgically Altered Anatomy.
abstract: Few studies have reported the outcomes of self-expandable metal stent (SEMS) placement for malignant biliary obstruction in patients with surgically altered anatomy.
  
  
  
  To evaluate the outcomes of biliary metal stent placement with the use of a short-type single-balloon enteroscope (working length, 1520 mm; channel diameter, 3.2 mm) in such patients.
  
  
  
  We retrospectively studied 13 malignant biliary obstructions treated by SEMS placement. Technical success rate, functional success rate, time to recurrent biliary obstruction (RBO), and complications were evaluated.
  
  
  
  Technical success rate was 100 % (13/13), functional success rate was 92 % (12/13), and the median time to RBO was 247 days (95 % CI 205.6-285.5). Complications comprised mild pancreatitis in one patient. Uncovered SEMSs were placed in three obstructions, partially covered SEMS in five obstructions, and fully covered SEMSs in five obstructions. Three stents occluded (two ingrowths and one mucosal hyperplasia), and one symptomatic distal stent migration occurred after more than 30 days from placement.
  
  
  
  A short-type single-balloon enteroscope was useful for the placement of various SEMS in this patient population with satisfactory outcomes.
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan. yhiroshi@kitasato-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamauchi
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Okuwaki
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyazawa
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaizumi
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Miyata
authors.initials: M
authors.lastname: Eiji
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Rikiya
authors.initials: R
authors.lastname: Hasegawa
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D000071087:Balloon Enteroscopy / Q000295:instrumentation; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D002277:Carcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
keywords: ERCP; Malignant biliary obstruction; Metal stent; Single-balloon enteroscope; Surgically altered anatomy