Usefulness of self‐expandable metal stents for malignant biliary obstruction using a short‐type single‐balloon enteroscope in patients with surgically altered anatomy

Objectives To evaluate the efficacy and safety of self‐expandable metal stent (SEMS) placement for unresectable malignant biliary obstruction (MBO) using a short‐type single‐balloon enteroscopy (short SBE) in patients with surgically altered anatomy (SAA). Methods The technical success rate, clinical success rate, recurrent biliary obstruction (RBO), time to RBO (TRBO), procedure related adverse events, and reintervention after RBO were evaluated from September 2011 to June 2020. Results Thirty‐seven patients (11 patients with distal MBO and 26 with hilar MBO) who underwent SEMS placement were included in the analysis. The technical and clinical success rates were 100% and 94.6%. Seven patients underwent bilateral stenting (partial stent‐in‐stent placement) for hilar MBO. The RBO rate was 13.5% (5/37) and the median TRBO was 212 (interquartile range [IQR], 154‐296) days. No food impaction occurred in this study. Procedure related adverse events occurred in 5.4% (2/37) of cases. Reintervention was attempted in five patients and all succeeded (four patients underwent SEMS replacement, and one underwent plastic stent placement). Conclusions SEMS placement for unresectable MBO using a short SBE in patients with SAA is effective and safe in similar ways to that in patients with normal anatomy in terms of bilateral stenting, stent patency, and reintervention. Tanisaka and colleagues demonstrated that the efficacy and safety of self‐expandable metal stent placement for unresectable malignant biliary obstruction using a short‐type single‐balloon enteroscope in patients with surgically altered anatomy is comparable to that in patients with normal anatomy in terms of bilateral stenting, stent patency, and reintervention.