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Updated: Sep 13, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Prospective evaluation study of a novel endoscopic revision technique after metal stent deployment for hepatic hilar
Kouji Kamawaki1, Takeshi Ogura2,3,1, Saori Ueno4,1
1Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Background:
Malignant hilar biliary obstruction (MHBO) can be treated by stent deployment under endoscopic retrograde cholangiopancreatography. In case of unresectable MHBO, uncovered self-expandable metal stent (UCSEMS) deployment might be recommended. However, endoscopic revision is challenging. To overcome this issue, we previously described a novel revision technique called the "molting technique," but its technical feasibility is still unclear.
Objective:
The present study aimed to evaluate the technical feasibility of the molting technique in a prospective setting.
Design:
A single-center prospective study.
Methods:
Technical success was defined as successful endoscopic revision using the molting technique. If endoscopic revision using the molting technique in the hepatic bile duct failed on either side, the technique was considered a technical failure.
Results:
A total of 20 patients were prospectively enrolled in this study. The technical success rate was 90% (18/20). The mean procedure time was 20.6 ± 8.5 min, and clinical success was obtained in 94.4% of patients (17/18). The mean duration of stent patency after endoscopic revision was 118.2 days. Finally, adverse events were observed in three patients (pancreatitis, n = 2, cholangitis, n = 1), all of whom were successfully treated conservatively.
Conclusion:
In conclusion, the molting technique might be helpful as an option for endoscopic revision for multiple UCSEMS deployments for selected patients.
Trail Registration:
University Hospital Medical Information Network 000044572.
