Seventeen patients with malignant biliary
strictures have been treated by endoscopic insertion of self-expandable metallic
prostheses. Two patients received two
prostheses inserted simultaneously in both the left and right hepatic ducts for
Klatskin tumor type III. Immediate results were satisfactory despite an operative mortality of 18%, and neither early nor late clogging was observed even in patients who presented previously with sludge above
plastic stents that were removed. However, among five patients followed for more than 4 months, two presented with obstruction due to
tumor ingrowth into the
stent through the metallic mesh. Accordingly, initial enthusiasm concerning long-term patency of these
stents has decreased. However, we describe a technique of "diathermic cleaning" of
tumor ingrowth which can easily restore the
stent patency. The advantages of these wire mesh 30 F
stents are their easier insertion, better immediate drainage, and absence of dislocation or perforation.