Misplacement of endoscopic biliary endoprostheses

Four patients with cholangiocarcinoma involving the common hepatic duct or the confluence of the hepatic ducts are described here, in whom endoscopically placed endoprostheses were unknowingly misplaced, with their proximal portions lying outside the bile duct system. Because of persisting jaundice, the stents were changed endoscopically in three cases on several occasions, but the misplacement was not recognized. The problem was recognized during percutaneous transhepatic cholangiography in all four patients, with percutaneous stent placement allowing resolution of the jaundice. The avoidance and management of this complication is discussed.