Large-diameter therapeutic channel duodenoscope to facilitate simultaneous deployment of side-by-side self-expandable metal stents in hilar cholangiocarcinoma

BackgroundHilar cholangiocarcinoma (CC) is unresectable in 80% to 90% of cases. Placement of side-by-side bilateral self-expandable metal stents (SEMSs) can be technically challenging in these patients because deployment of the first stent can preclude passage of the second stent.MethodsUsing a prototype large-diameter therapeutic channel (6-mm) duodenoscope, we positioned guidewires into the right and left intrahepatic systems. Two predeployed uncovered SEMSs with 7.5F delivery systems were passed side by side over each guidewire and deployed simultaneously.DesignObservational clinical feasibility study.SettingTertiary referral center.ResultsThis technique was attempted in 6 patients with malignant hilar biliary obstruction. Successful placement was achieved in all, with significant improvement in symptoms and cholestasis.LimitationsSmall number of patients.ConclusionThis simple technique using a prototype large-diameter therapeutic channel duodenoscope facilitates placement of bilateral side-by-side hilar SEMSs.