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Life sciences · Journal article
Den Open · September 3, 2026
Encouraging direction, but not yet definitive.
This retrospective case series reports a novel 'long-anchoring stent' technique (placement of a double-pigtail plastic stent through an angulated covered SEMS) as a rescue intervention for early dysfunction of covered self-expandable metal stents in distal malignant biliary obstruction. Clinical success was achieved in all 15 patients, with significant straightening of SEMS angulation (128.3° to 151.5°, p<0.001) and median follow-up of 307 days; no severe procedure-related adverse events were reported.
Retrospective case series. 15 patients with distal malignant biliary obstruction treated at Osaka International Cancer Institute, Japan. Inclusion: initial covered SEMS placement with subsequent clinical failure or early recurrent biliary obstruction within 90 days, treated with long-anchoring stent method. Exclusion: hilar…. Intervention: Long-anchoring stent method: placement of a double-pigtail plastic stent through an angulated covered SEMS, with distal end positioned beyond the SEMS into the duodenum (ideally horizontal portion). SEMS types included Niti-S ComVi, BONAST…. n = 15. Single centre: Osaka International Cancer Institute, Japan.
Clinical success achieved in all 5 patients with initial SEMS clinical failure Clinical success achieved in all 15 patients overall Median SEMS angle straightened from 128.3° to 151.5° after anchoring stent placement (p<0.001)
No data on cost, procedure time, or detailed adverse event rates; patient baseline characteristics and cancer types not fully described. No severe procedure-related adverse events occurred
This technique offers a potential rescue option for early covered SEMS dysfunction in distal malignant biliary obstruction, with the advantage of being simple and avoiding the need for stent exchange in some cases. However, the lack of a comparator arm (e.g., standard stent exchange) and small sample size limit definitive recommendations; confirmation in a prospective comparative trial is needed before widespread adoption.
A retrospective case series of 15 patients showing 100% clinical success with a novel rescue technique for early SEMS dysfunction, with measurable mechanical improvement (SEMS angle 128.3° to 151.5°, p<0.001) and no severe adverse events, but limited by single-centre design, small sample, lack of comparator, and retrospective methodology.
As stated by the source record.
Quoted from the source exactly as published.
This technique offers a potential rescue option for early covered SEMS dysfunction in distal malignant biliary obstruction, with the advantage of being simple and avoiding the need for stent exchange in some cases. However, the lack of a comparator arm (e.g., standard stent exchange) and small sample size limit definitive recommendations; confirmation in a prospective comparative trial is needed before widespread adoption.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Objective. Covered self-expandable metal stents (SEMS) are widely used for treating distal malignant biliary obstruction (MBO). Severe SEMS angulation can cause stent dysfunction. Placement of a long double-pigtail plastic stent inside the SEMS (the "long-anchoring stent method") may straighten the angulated SEMS, thereby achieving effective biliary drainage. This study aimed to report the clinical outcomes of this novel method.Methods. We retrospectively analyzed 15 patients with distal MBO who underwent initial SEMS placement, subsequently experienced clinical failure or early recurrent biliary obstruction (RBO) within 90 days of initial placement, and underwent reintervention with the long-anchoring stent method between April 2020 and March 2025.Results. The median follow-up period was 307 days after the anchoring procedure. For the primary outcome, clinical success was achieved in all 5 patients with initial SEMS clinical failure and in all 15 patients overall. The median angle of the SEMS significantly straightened from 128.3° with the initial SEMS alone to 151.5° after anchoring stent placement (p < 0.001). As an exploratory analysis of the 10 patients with early RBO, the median time to RBO increased from 21 days after initial SEMS placement to 148 days after anchoring procedure. No severe procedure-related adverse events occurred.Conclusion. The long-anchoring stent method is a simple, safe, and viable strategy for rescuing early dysfunction of covered SEMS, possibly in part through straightening of the SEMS angulation.Trial registration. N/A.
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