Endoscopic reintervention for stent malfunction after stent-in-stent deployment for malignant hilar obstruction

Endoscopic bilateral stenting has been increasingly performed for advanced hilar obstruction. As disease progresses, stent malfunction eventually occurs. However, endoscopic reintervention is difficult in these patients. We aimed to evaluate a suitable reintervention procedure for stent malfunction after stent-in-stent (SIS) deployment for malignant hilar obstruction. Among 52 patients with bilateral stenting performed using the SIS method between September 2009 and June 2016, 20 patients with stent malfunction were enrolled in this study. Reintervention was performed endoscopically or percutaneously. Technical and functional success rates were evaluated retrospectively. Technical and functional success rates of endoscopic reintervention were 83% (10/12) and 80% (8/10), respectively. Endoscopic bilateral and unilateral reintervention success rates were 75% (6/8) and 100% (4/4), respectively. For bilateral reintervention, either plastic or plastic and metal stents were used. Endoscopic reintervention could be considered for in-stent malfunction if patients are in fair condition after SIS placement for malignant hilar obstruction. Decisions regarding whether to use bilateral or unilateral drainage and the type of stent to use should depend on the conditions of the disease and the patient.