Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy

Endoscopic intervention is less invasive than percutane- ous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice. Recently, therapeutic endoscopic retrograde cholangiopancreatography （ERCP） using double-balloon enteroscopy （DBE） has been shown to be feasible and effective, even in patients with surgi- cally altered anatomies. On the other hand, endo- scopic partial stent-in-stent （PSIS） placement of self- expandable metallic stents （SEMSs） for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible, safe and effective. We performed PSIS placement of SEMSs for malignant hilar biliary ob- struction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved tech- nical and clinical success. This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization, even in patients with surgically altered anatomies.