Endoscopic irradiation and parallel arrangement of Wallstents for hilar cholangiocarcinoma

The placement of two Wallstents in parallel seems to be a common solution for endoscopic technique in order to obtain bilateral hepatic drainage in patients with hilar biliary strictures. However, a biliary stricture at the hepatic confluence hinders the sequential delivery of multiple Wallstents. Intraductal irradiation has been shown to recanalize the cancerous stricture caused by cholangiocarcinoma.

We attempted to place two Wallstents in parallel by endoscopic means after endoscopic intraductal irradiation with a high-dose rate afterloading device in three patients with hilar cholangiocarcinoma. After the placement of two guidewires into the bilateral hepatic ducts, two Wallstents were sequentially delivered over the guidewires.

Owing to adequate re-opening of the hilar bile ducts after irradiation, the delivery of the second Wallstent alongside the expanded first Wallstent could be readily accomplished in all of the patients without complications. Two Wallstents were placed so that their distal ends were juxtaposed in the common bile duct, ensuring good drainage. There were no signs of recurrent biliary obstruction in any of the patients during the follow-up period of 24 to 44 weeks.

This endoscopic technique seems to be simple, safe, and reliable in obtaining bilateral hepatic drainage with Wallstents in patients with hilar cholangiocarcinoma.