Additional stenting for hilar cholangiocarcinoma using a novel delivery device after uncovered metallic stent placements.

An 86-year-old man who had undergone placement of multiple uncovered self-expandable metal stents (U-SEMSs) by the stent-in-stent (SIS) method for hilar cholangiocarcinoma presented with fever. Blood tests revealed elevated levels of inflammatory markers and liver enzymes. Computed tomography showed intrahepatic bile duct dilatation due to U-SEMS obstruction caused by tumor ingrowth, and peripheral early enhancement probably due to cholangitis ([Fig. 1]).