Double novel integrated outside biliary stent and nasobiliary drainage catheter system placement for hilar biliary stricture

Abstract

A novel integrated biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent [UMIDAS]; Olympus Medical Systems, Tokyo, Japan) was recently renewed.^{1, 2} The renewed UMIDAS consists of a 7F or 8.5F outside biliary stent with a large flap on the distal side to prevent migration and a 5F nasobiliary catheter (Fig. 1). The advantage of the UMIDAS is that additional endoscopic retrograde cholangiopancreatography is not required because internal drainage can be achieved by simply removing the nasobiliary catheter.^{3, 4} However, because of the large 8.5F diameter of the stent pushing sheath, it is impossible to deploy two UMIDASs through the scope channel. Here, we present a technique demonstrating the placement of two UMIDASs (Video S1).

External drainage of the right anterior and posterior bile ducts was planned before left hepatic lobectomy for hilar biliary stricture resulting from cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography was performed using a duodenoscope (TJF-Q290V; Olympus Medical Systems). After bile duct cannulation, 0.025 inch guidewires were inserted into the anterior and posterior branches, followed by endoscopic sphincterotomy. Next, a UMIDAS with a 7F biliary stent was inserted into the anterior branch across the papilla. Because a second UMIDAS could not be inserted through the 4.2 mm diameter scope channel, pushing sheath and nasocatheter of the first UMIDAS were temporarily removed while retaining the biliary stent and guidewire in place (Fig. 2a). This allowed the second UMIDAS to be inserted through the channel and placed in the posterior branch (Fig. 2b). After removing the pushing sheath of the second UMIDAS, the nasocatheter of the first UMIDAS was reinserted through the lumen of the biliary stent and placed in the anterior branch (Fig. 2c,d).

A week later, the nasobiliary catheters were successfully extracted under fluoroscopic guidance while the biliary stents were retained in place.

Authors declare no conflict of interest for this article.