Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction

Figure 2 Liver metastasis and postoperative gastric cancer in a 61-years old male patient. A: Abdominal contrast-enhanced computed tomography indicates an extensive malignant tumor in the hepatic left lobe, enlargement of the gallbladder, dilation of intrahepatic bile duct branches, abdominal and retroperitoneal lymph nodes metastasis, and ascites; B: Cholangiography shows hilar biliary obstruction, Bismuth type IV. Intraductal biopsy revealed adenocarcinoma; C: Double wires and double 6 French guiding tubes were selected for the common bile duct and the left intrahepatic bile duct, respectively; D: Double iodine-125 (¹²⁵I) seed strip combined with double self-expandable metallic stent implantation (type T). The right bile duct is connected to the common bile duct (8 mm × 80 mm, 16 ¹²⁵I seeds); the right bile duct is connected to the left bile duct (8 mm × 60 mm, 14 ¹²⁵I seeds).