Abstract
A 84-year-old male was admitted to our hospital because of jaundice and diagnosed as having inoperable cholangiocarcinoma at the hilum of the liver. Endoscopic retrograde cholahgiopancreatography (FRCP) revealed a severe stricture of bilateral hepatic bile ducts and two endoscopic naso-biliary drainage (ENBD) tubes were inserted into each hepatic bile duct. As serum bilirubin level decreased day by day, we attempted to implant two pieces of self-expandable metallic stents, Wallstent, on his 15th day in hospital. One Wallstent was introduced and implanted along the left ENBD tube. Subsequently, duodenoscope was inserted again and the other Wallstent was implanted along the right ENBD tube. Although the first stent was already implanted, it was easy to insert the second stent and both of two stents were expanded adequately. The patient was discharged on his 22nd day in hospital. No obstruction of the stents occured and he died of heart failure 3 months later. While transpapillary stenting is very useful to shorten hospital stay, it had been presumed impossible to duodenoscopically implant two pieces of self-expandable metallic stents into bilateral hepatic bile ducts. However, we experienced a case with cholangiocarcinoma at the hilum in whom two pieces of Wallstents could be implanted simultaneously using duodenoscopy.
