Percutaneous bilateral metallic stent placement using a stentin-stent deployment technique in patients with malignant hilar biliary obstruction.
PURPOSE Modified Gianturco Z stents were used in five patients with hilar cholangiocarcinoma to permit bilobar hepatic drainage via a single percutaneous tract. PATIENTS AND METHODS After successful negotiation of strictures from the ipsilateral hepatic duct to the contralateral hepatic duct and the common bile duct, a modified endoprosthesis--made by connecting two double-body Z stents with two stainless steel wires in order to leave a space in between--was implanted in one stricture and a 'space' was located at the hepatic confluence. A second endoprosthesis, a two- to six-body Z stent, was introduced into the second stricture through the 'space' of the initial endoprosthesis and was implanted so that a part of the endoprosthesis should overlap the initial endoprosthesis. RESULTS Optimal positioning of the two endoprostheses was successful in all patients. CONCLUSION The technique seems simple, safe, and reliable in reconstructing the bilateral hepatic ductal systems via a single percutaneous approach in patients with hilar cholangiocarcinoma.