Plastic Stent Placement Techniquein Treatment of MOJ Restenosis

Plastic Stent Placement Technique in Treatment of MOJ Restenosis

The restenosis in malignant obstructive jaundice after metal stent implantation has the occurrence rate of 20% to 86%.  The important elements that could lead to restenosis are tumor stage, obstruction position and concurrent infection. Plastic stent indwelling is presently used as the best solution of restenosis in this situation.

With the insertion of the first guide wire and thesecond guide wire reflexing into bile duct, we recommend that two plastic stents should beplaced into the stricture to achieve the satisfying drainage effect.

Operation Procedures

1. Find duodenal papilla under the duodenoscope. Insert sphincterotomepreloaded with guide wire. Pass the guide wire over the stricture and avoid the guide wire from penetrating into the web hole of metal stent. Leave the guide wire and retreat the sphincterotome.

2. Make dilation of papilla and bile duct before the insertion of the second guide wire.

3. Insert the second guide wire. Repeat the procedure as step 1.

4. Insert one stent through one guide wire.

5. Make dilation of papilla, and insert the other stent through the second guide wire.

The most difficult and important technique in this procedure is guide wire insertion.

With guide wire passing through the stricture, the operation is 50% successful.

There are two methods normally used for guide wire passing the stricture, accompanied with different choices of devices.

Method A: Guide wire preloaded in rotatable sphincterotome. By turning the direction of sphicterotome, adjust the position of guide wire. Check the position of the guide wire with the movement consistence of the sphincterotome.

Method B: use the guide wire with 10cm ultra slippery tip. Protrude the guide wire tip from the sphincterotome. Insert the sphincterotome. The tip of the guide wire is in reflected shape when it enters the bile duct. Once the sphincterotome passes the stricture, the folded tip will have the space to return to straight shape. In this way, it reaches the upper edge of metal stent.

By adopting the guide wire reflection method, this operation could be completed with less time, therefore it brings lower risk of anaesthesia, and less radiation to the operators. In our clinical experience, we recommend the guide wire reflection method for plastic stent implantation at this circumstance. It could prevent the guide wire from protruding into the web mesh of the metal stent. Evaluated from operation time and successful rate, it is a good technique to be used in plastic stent placement in treatment of MOJ restenosis.