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Tri-side-by-side stent deployment for hepatic hilar obstruction using fully covered self-expandable metal stents with a spiral-grooved outer surface

Year: 2026

Type: article

Abstract: In patietns with malignant hilar biliary obstruction (MHBO), stent deployment under endoscopic retrograde cholangiopancreatography (ERCP) can be considered a first-line treatment technique.[ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] Recently, similar stent patency has been reported between uncovered self-expandable metal stents and inside plastic stents. To obtain longer stent patency, fully covered SEMS (FCSEMS) deployment using a side-by-side technique (SBS) might be an option. However, FCSEMS deployment for MHBO is indicated for selected patients because of side bile duct branch obstruction. To overcome this issue, a novel FCSEMS with a spiral-grooved outer surface (6-mm diameter, 12-cm length, 6Fr stent delivery system, HIRZO Biliary Willow Stent; BCM Co., Ltd, Seoul, Korea) has been developed ([ Fig. 1 ]). We describe herein technical tips for tri-SBS using this stent for high-grade MHBO. Fig. 1 A fully covered self-expandable metal stent with a spiral-grooved outer surface (6-mm diameter, 6Fr stent delivery system, HIRZO Biliary Willow Stent; BCM Co., Ltd, Seoul, Korea). A 68-year-old man was admitted due to obstructive jaundice. Choledochoduodenostomy was performed due to gallbladder and bile duct stones. Based on computed tomography and upper gastrointestinal endoscopy, hilar cholangiocarcinoma with invasion of the choledochoduodenostomy site was diagnosed. The patient underwent plastic stent deployment, but recurrent biliary obstruction was identified as a complication after 1 month. Re-intervention was therefore attempted. First, an ERCP catheter was inserted into the biliary tract and the guidewire was deployed into the left hepatic bile duct. Guidewires were subsequently deployed at the anterior and posterior bile ducts ([ Fig. 2 ]). Based on cholangiography, all bile ducts were obstructed ([ Fig. 3 ]). The FCSEMS with a spiral-grooved outer surface was deployed at the left bile duct, and also deployed at the posterior bile duct using SBS ([ Fig. 4 ]). The stent delivery system for a FCSEMS with a spiral-grooved outer surface was easily and smoothly inserted into the anterior bile duct beside previously deployment stents, and successfully deployed without any adverse events ([ Fig. 5 ]; [ Video 1 ]). Computed tomography showed no bile duct branch obstruction. This patient received systematic chemotherapy, but died after 6 months. During this period, no stent dysfunction was observed. Fig. 2 Guidewires are deployed at the left hepatic and posterior bile ducts. Fig. 3 A guidewire is deployed at the anterior bile duct. Fig. 4 A fully covered self-expandable metal stent with a spiral-grooved outer surface is deployed at the left hepatic bile duct and the posterior bile duct using a side-by-side technique. Fig. 5 A stent delivery system for the fully covered self-expandable metal stent with a spiral-grooved outer surface can be smoothly inserted and successfully deployed into the anterior bile duct beside previously deployed metal stents. Video 1 Computed tomography after tri-side-by-side stent deployment using a fully covered self-expandable metal stent with spiral-grooved outer surface shows no bile duct branch obstruction by stents. Download Video In conclusion, tri-SEMS deployment by SBS using the FCSEMS with a spiral-grooved outer surface may open a new window to MHBO drainage. Endoscopy_UCTN_Code_TTT_1AR_2AZ Publication History Received: 19 May 2026 Accepted after revision: 01 June 2026 Article published online: 24 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Source: Endoscopy

DOI: 10.1055/a-2888-0596

Authors: Takeshi Ogura, Kimi Bessho, Junichi Nakamura, Nga Nguyen Trong, Hiroki Nishikawa

Institutions: Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Funders: National Natural Science Foundation of China, Wuhan University, Zhongnan Hospital of Wuhan University