Endoscopic technique for multiple metallic stent deployment to malignant hilar biliary strictures

Multiple metallic stent deployment to malignant hilar biliary strictures is not a mere technique to deploy metallic stents into the right and left hepatic ducts. This technique is technically demanding because it involves insertion of various devices repeatedly to selected branches with a lateral view endoscope. Consequently, the functional liver volume is secured as much as possible. Since inappropriate stent deployment may induce intractable cholangitis in patients with malignant hilar biliary strictures, we must pay attention to the anatomy of the biliary tree on the hilar plate and must be familiar with the available devices. Otherwise, the prognosis of these patients is ominous. To conduct multiple metallic stent deployment successfully, it is important to develop a strategy based on these facts.