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Triple Covered Metal Stent Deployment Using Side-by-Side Technique for Hemobilia due to Hepatocellular Carcinoma
Takeshi Ogura1, Tadahiro Yamada2, Masanori Yamada2
12nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan, oguratakeshi0411@yahoo.co.jp.
Insights
Hepatocellular carcinoma (HCC) invading the biliary tract can cause hemobilia. This report details a triple covered metal stent technique for managing hemobilia in HCC patients, offering drainage and hemostasis.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) rarely invades the biliary tract, potentially leading to complications like cholangitis or hemobilia.
- Surgical intervention for HCC with bile duct invasion can be challenging, especially in patients with poor general condition.
Observation:
- This report presents technical tips for a triple covered metal stent deployment using a side-by-side technique.
- The technique involves guidewire placement in the left, anterior, and posterior bile ducts, followed by 6-mm covered self-expandable metal stents.
Findings:
- The described technique facilitates effective management of hemobilia secondary to HCC.
- Successful deployment provides both biliary drainage and hemostasis in cases of high-grade hepatic hilar obstruction.
Implications:
- This approach offers a less invasive option for managing hemobilia in HCC patients unsuitable for extensive surgery.
- The technique may be beneficial for achieving palliation and improving quality of life in selected HCC patients with biliary involvement.
Abstract:
A hepatocellular carcinoma (HCC) rarely expands into the biliary tract. In this situation, because of its hypervascular nature, cholangitis or hemobilia may sometimes occur. Surgery is one of the options in this situation. However, patients with HCC and bile duct invasion are sometimes in a poor general condition, as in the case presented in this report. For such patients, surgical treatment may need to be invasive. Thus, here we report technical tips for triple covered metal stent deployment using side-by-side technique for hemobilia due to HCC. After guidewire deployments at the left, anterior, and posterior bile ducts, 6-mm covered self-expandable metal stents were placed at each bile duct. This may be useful for high-grade hepatic hilar obstruction due to HCC because drainage and hemostasis effects are obtained.
