Efficacy and safety of self-expandable metal stent placement for malignant biliary obstruction using a short type single-balloon enteroscope in patients with surgically altered anatomy

Aim: To evaluate the efficacy and safety of self-expandable metal stent (SEMS) placement for malignant biliary obstruction using a short type single-balloon enteroscope (short SBE) in patients with surgically altered anatomy (SAA).
Methods: We evaluated patients who underwent SEMS placement using a short SBE (SIF-H290S; Olympus Medical Systems), which has a working length of 152 cm and a 3.2 mm forceps channel, from July 2013 to January 2025. 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.
Results: Overall, 66 patients (17 with distal MBO and 49 with hilar MBO) were included in the analysis. The technical and clinical success rates were 100% and 95.5%, respectively. Eleven patients underwent bilateral stenting (partial stent-in-stent placement) for hilar MBO. The rate of RBO was 15.2% (10/66), and TRBO was 190 days. Procedure-related adverse events occurred in 4.5% (3/66) of cases. Reintervention was attempted in 10 patients, with all procedures successful. Five patients underwent SEMS replacement, and five plastic stent placement.
Conclusions: SEMS placement for MBO using a short SBE in patients with SAA was effective and safe, similar to that in patients with normal anatomy, in terms of bilateral stenting, stent patency, and reintervention.