Simultaneous side-by-side self-expanding metal stent placement using a two-channel endoscope for a bilioenteric stricture after Child's resection.

Recently, balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been attempted to treat malignant choledochojejunal anastomotic stenosis. The development of short-type balloon enteroscopes with large-channel diameter has increased the number of instruments that can be used, allowing complex surgical procedures to be performed [1–3]. However, bilateral biliary drainage is technically very difficult in patients whose right and left bile ducts have been displaced. Patients’ quality of life can be markedly compromised if percutaneous transhepatic cholangiodrainage is also required. We describe a 69-year-old man with extrahepatic bile duct cancer who underwent a Child’s resection. Simultaneous side-by-side placement of self-expanding metal stents (SEMSs) was performed using a two-channel endoscope for treatment of his malignant choledochojejunal anastomotic stricture. The malignant stricture had recurred 14 months after surgery, and obstructive jaundice had developed. ●" Fig.1 shows a three-dimensional magnetic resonance cholangiopancreatography (MRCP) image obtained at the time of the recurrence. A two-channel endoscope (GIF-2T240; Olympus Medical Systems, Tokyo, Japan) was inserted into the site of choledochojejunostomy, taking 13 minutes (●" Fig.2). Guidewires were placed into the left and right bile ducts from each channel. Zilver Fig.1 A three-dimensional magnetic resonance cholangiopancreatography (MRCP) image at the time when the stenosis recurred 14 months after surgery showing diffuse dilatation of the left and right intrahepatic bile ducts and apparent displacement of the left and right bile ducts.