Post written by Mitsuru Okuno, MD, PhD, from the Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.

Managing consequent jaundice caused by malignant hilar biliary obstruction (MHBO) is important. Endoscopic biliary drainage is the treatment of choice because of its limited invasiveness. However, in patients with surgically altered anatomy, especially those who have undergone Roux-en-Y bypass surgery, ERCP is challenging. This video shows the bilateral stent-in-stent self-expandable metal stent (SEMS) placement method for unresectable MHBO with Roux-en-Y anatomy case using the direct cholangioscopy with a short double-balloon endoscopy.

This method is one of the drainage options for MHBO with Roux-en-Y anatomy cases. When the short double-balloon endoscopy can insert into common bile duct, it makes it easier to perform bilateral stent-in-stent placement.

This method is a useful technique. This method can be performed in patients with dilated common bile duct and requires the use of a short double-balloon endoscopy, which has a short working length.

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