Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients

Figure 1 Patient flowchart. DMBO: Distal malignant biliary obstruction; SEMS: Self-expandable metallic stent; CBD: Common bile duct.

Figure 2 Representative cases from each group. A and B: A patient with distal malignant biliary obstruction (DMBO) in the Hilar group who underwent self-expandable metallic stent (SEMS) placement near the biliary hilar duct; C and D: A patient with DMBO in the Lower group who underwent SEMS placement near the top of the biliary obstruction.

Figure 3 A patient with closure of the top edge of the self-expandable metallic stent by the common bile duct wall. A: A patient with distal malignant biliary obstruction who underwent uncovered self-expandable metallic stents (USEMS) placement near the top of the biliary obstruction; B: The top edge of the SEMS was closed by the common bile duct wall (arrows). Upper bile tract dilation was observed; C: An additional USEMS was placed near the biliary hilar duct.

Figure 4 Comparison of stent patency period based on factors that were significantly different between the Hilar group and Lower group. A: Stent placement position (Hilar group vs Lower group); B: Use of the covered WallFlex stent; C: Use of the covered X Suit NIR stent; D: Observational period (< 2.5 mo vs ≥ 2.5 mo).