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

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.

We retrospectively reviewed five patients (four women and one man; median age, 68 years) with malignant biliary obstruction who underwent one-stage percutaneous SEMS placement between April 2016 and March 2025 at the Tokai University Hospital. The procedures were performed under ultrasonographic guidance using a 19-gauge EVS^™ needle, followed by guidewire exchange, tract dilation with an 8-Fr dilator, and deployment of an Epic^™ biliary SEMS. Technical and clinical success and procedure-related complications were evaluated.

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.

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.