Tsuyoshi Hamada, Yousuke Nakai, Saburo Matsubara, Akiko Narita, Kazuhiro Watanabe, Yukihiro Koike, Shigeo Matsukawa, Tateo Kawase, Department of Gastroenterology, Kanto Central Hospital, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo, 158-8531, Japan
Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan
Author contributions: Hamada T drafted this article; Nakai Y, Matsubara S, Isayama H, Narita A, Watanabe K, Koike Y, Matsukawa S and Kawase T revised this article critically for important intellectual content; Koike K gave final approval of this article.
Correspondence to: Yousuke Nakai, MD, PhD, Assistant Professor, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan. ynakai-tky@umin.ac.jp
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Received: November 2, 2010 Revised: December 27, 2010 Accepted: January 3, 2011 Published online: July 28, 2011
Abstract
In endoscopic placement of multiple plastic biliary stents (PBSs), we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion. We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis. Although proximal dislocation of the first PBS was observed, we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire. We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath. It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb. Here we introduce this “anchor-wire technique”, which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.
