Breaking the barrier: Using extractable fully covered metal stents to treat benign biliary hilar strictures

Background: Most benign biliary strictures nowadays are managed endoscopically with plastic stents or with a insertion of a fully covered self-expandable metal stent (fcSEMS). The paradigm for the treatment of benign hilar strictures precludes the use of an fcSEMS because it obstructs the intrahepatic bile ducts, in particular, the contralateral hepatic duct. It is unknown whether use of a plastic stent in the opposite hepatic duct after deployment of an fcSEMS across the liver hilum provides an adequate solution for this problem. Objective: To evaluate the use of an fcSEMS in combination with a contralateral plastic stent in the treatment of benign hilar strictures. Design: Case series. Setting: Tertiary referral hospital. Patients: Two consecutive patients with benign hilar strictures. Interventions: Placement of an intrahepatically deployed fcSEMS in conjunction with a contralateral 10F plastic stent for 4 to 5 months followed by stent removal and cholangiogram. Main Outcome Measurements: Clinical and laboratory follow-up of at least 9 months. Results: In both patients, the indwelling period of the stents was uneventful as was stent removal. Both strictures resolved, and there were no clinical or biochemical signs of a recurrent stricture. Limitations: Small number of patients. Conclusions: Treatment of benign hilar strictures with an fcSEMS deployed across the liver hilum in conjunction with a contralateral plastic stent placement is feasible without ensuing cholangitis caused by bile duct occlusion.