One-Stage Percutaneous Self-Expandable Metal Stent Placement for Malignant Biliary Obstruction: A Five-Case Series.

Abstract

OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) with self-expandable metal stent (SEMS) placement is the standard treatment for malignant biliary obstruction; however, it may not be feasible in cases of duodenal invasion, altered anatomy, or failed cannulation. Although percutaneous transhepatic biliary drainage is a reliable alternative, it is associated with external catheter-related complications and impaired quality of life. Recently, a one-stage percutaneous SEMS placement procedure has been proposed to overcome these limitations. METHODS: biliary SEMS. Technical and clinical success and procedure-related complications were evaluated. RESULTS: Herein, the underlying diseases included pancreatic head carcinoma (n = 1), postoperative cholangiocarcinoma with lymph node recurrence (n = 2), postoperative gallbladder carcinoma with lymph node recurrence (n = 1), and postoperative gastric carcinoma with peritoneal dissemination (n = 1). ERCP failure was due to the following reasons: duodenal stenosis, choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with cannulation failure, laparoscopic SSPPD not attempted due to inflammation, and Roux-en-Y reconstruction. Three and two patients presented with moderate and mild cholangitis, respectively, as per the Tokyo Guidelines 2018. Technical success was achieved in all patients. No procedure-related complications occurred. CONCLUSION: One-stage percutaneous SEMS placement is a safe and effective option for treating malignant biliary obstruction in patients unsuitable for ERCP or endoscopic ultrasound-guided biliary drainage. With careful case selection, this approach enables rapid biliary decompression without external drainage and may improve the patient's quality of life.