Stent-in-stent deployment above the papilla to treat malignant hepatic hilar biliary obstruction using novel fully covered multi-hole metal stent.

Fully covered self-expandable metal stents (FCSEMSs) are usually used for malignant hilar biliary obstruction because they can be removed if required and provide longer stent patency by preventing tissue ingrowth [1] [2]; however, their use in the hepatic hilum carries the risk of blocking the side branches of the hepatic ducts and stent migration [3] [4] [5]. Furthermore, stent-in-stent techniques are unfeasible. A new FCSEMS with multiple holes was introduced to address these problems. We report successful stent-in-stent bilateral metal stent deployment using this novel FCSEMS (HANARO Biliary Multi-Hole NEO; M.I. Tech Co., Ltd, Pyeongtaek, South Korea) ([Fig. 1]) for malignant hilar biliary obstruction.