ENDOSCOPIC IRRADIATION AND PARALLEL ARRANGEMENT OF WALLSTENTS FOR HILAR CHOLANGIOCARCINOMA

BACKGROUND/AIMS: The placement of two Wallstents in parallel seems to be a common solution for endoscopic technique in order to obtain bilat eral hepatic drainage in patients with hilar biliary strictures. Howev er, a biliary stricture at the hepatic confluence hinders the sequenti al delivery of multiple Wallstents. Intraductal irradiation has been s hown to recanalize the cancerous stricture caused by cholangiocarcinom a. METHODOLOGY: We attempted to place two Wallstents in parallel by en doscopic means after endoscopic intraductal irradiation with a high-do se rate afterloading device in three patients with hilar cholangiocarc inoma. After the placement of two guidewires into the bilateral hepati c ducts, two Wallstents were sequentially delivered over the guidewire s. RESULTS: Owing to adequate re-opening of the hilar bile ducts after irradiation, the delivery of the second Wallstent alongside the expan ded first Wallstent could be readily accomplished in all of the patien ts without complications. Two Wallstents were placed so that their dis tal ends were juxtaposed in the common bile duct, ensuring good draina ge. There were no signs of recurrent biliary obstruction in any of the patients during the follow-up period of 24 to 44 weeks. CONCLUSION: T his endoscopic technique seems to be simple, safe, and reliable in obt aining bilateral hepatic drainage with Wallstents in patients with hil ar cholangiocarcinoma.