Side-by-side placement of bilateral endoscopic metal stents for the treatment of postoperative biliary stricture

Abstract

Postoperative biliary strictures are usually complications of cholecystectomy. Endoscopic plastic stent prosthesis is generally undertaken for treating benign biliary strictures. Recently, fully covered metal stents have been shown to be effective for treating benign distal biliary strictures. We present the case of a 53-year-old woman with liver injury in which imaging studies showed a common hepatic duct stricture. Endoscopic retrograde cholangiopancreatography also confirmed the presence of a common hepatic duct stricture. Temporally fully covered metal stents with dilated diameters of 6 mm were placed in a side-by-side fashion in the left and right hepatic ducts, respectively. We removed the stents 2 months after their placement. Subsequent cholangiography revealed an improvement in the biliary strictures. Although we were apprehensive about the fully covered metal stents obstructing the biliary side branches, we noted that careful placement of the bilateral metal stents did not cause any complications. Side-by-side deployment of bilateral endoscopic fully covered metal stents can be one of the safe and effective therapies for postoperative biliary stricture.

Surgical outcomes in dogs with tracheal collapse treated with a novel cross-and-hook braided endoluminal stent

“…Although all self-expanding stents made of Nitinol may seem to have similar properties, it should be noted that the stent properties vary considerably depending on the braiding method. In recent years, cross-and-hook-net Nitinol stents have been adopted in human medicine [ 21 22 ]. There are two known weaknesses of the conventional cross-braided tracheal stent: first, they are vulnerable to external forces acting in the direction of the long-axis and are prone to elongation, and second, there is a risk of constant stimulation of the surrounding tissues due to their ability to be restored to their initial shape in response to external forces in the transverse axis and in three dimensions.…”

“…Second, it can change its shape in response to bending, shearing, and twisting forces, which allows it to follow the three-dimensional movement of the trachea and adapt its shape to the tracheal wall. Third, each cell can maintain its independent shape, which allows for stent-in-stent or multi-stent placement, (in which multiple stents are added to the metal gap) if needed [ 21 22 ]. However, reported problems such as stent migration, fracture, shortening after implantation, and coughing caused by physical irritation highlight the fact that current tracheal stents still require improvement [ 6 12 24 ].…”