Single‐step simultaneous side‐by‐side placement of a self‐expandable metallic stent with a 6‐ F r delivery system for unresectable malignant hilar biliary obstruction: a feasibility study

Background Bilateral self‐expandable metallic stent ( SEMS ) placement for the management of unresectable malignant hilar biliary obstruction ( UMHBO ) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6‐ F r delivery systems could facilitate a single‐step simultaneous side‐by‐side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure. Methods Between M ay and S eptember 2013, 13 consecutive patients with UMHBO underwent a single‐step simultaneous side‐by‐side placement of SEMS with the 6‐ F r delivery system. The technical success rate, stent patency, and rate of complications were evaluated from the prospectively collected database. Results Technical success was achieved in 11 (84.6%, 95% confidence interval [ CI ]: 57.8–95.8) patients. The median procedure time was 25 min. Early and late complications were observed in 23% (one segmental cholangitis and two liver abscesses) and 15% (one segmental cholangitis and one cholecystitis) patients, respectively. Median dysfunction free patency was 263 days (95% CI : 37–263). Five patients (38%) experienced stent occlusion that was successfully managed by endoscopic stent placement. Conclusions A single‐step simultaneous side‐by‐side placement of SEMS with a 6‐ F r delivery system was feasible for the management of UMHBO .