Endoscopic retrograde cholangiopancreatography (ERCP) with placement of self-expandable metal stents (SEMS) is the standard of care for malignant biliary obstruction. However, ERCP may be infeasible in patients with duodenal invasion, surgically altered anatomy, or failed biliary cannulation. Percutaneous transhepatic biliary drainage is an established alternative, but it often requires external catheters associated with device-related complications and reduced patient quality of life. To address these limitations, a one-stage percutaneous SEMS placement technique has been proposed to permit internal biliary drainage in a single session without leaving external catheters.
This report is a retrospective review of five consecutive patients treated at Tokai University Hospital between April 2016 and March 2025. All included patients had malignant biliary obstruction and were judged unsuitable for ERCP or endoscopic ultrasound-guided biliary drainage. The case series design and institutional setting are reported in the source. No additional selection criteria or exclusion details beyond those in the source were provided.
All procedures were performed under ultrasonographic guidance. The percutaneous access was obtained using a 19-gauge EVS™ needle. After access, guidewire exchange was performed, the tract was dilated using an 8-Fr dilator, and an Epic™ biliary self-expandable metal stent was deployed in the same session. The sequence—needle puncture, guidewire exchange, tract dilation with an 8-Fr dilator, and SEMS deployment—constituted the one-stage approach described in the source.
Five patients (four women and one man) with a median age of 68 years underwent the one-stage percutaneous SEMS procedure. Underlying malignant diseases reported were:
ERCP attempts had failed or were contraindicated for the following reasons cited in the report: duodenal stenosis, presence of a choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with failed cannulation, inflammation that prevented laparoscopic SSPPD attempts, and Roux-en-Y reconstruction. These anatomic and technical impediments motivated selection of the percutaneous one-stage approach.
Severity of cholangitis in the cohort was reported according to the Tokyo Guidelines 2018: three patients presented with moderate cholangitis and two with mild cholangitis. The source did not provide further clinical scores, laboratory values, or timing of symptom onset beyond these categorizations.
Technical success of stent placement was achieved in all five patients in this series. The authors reported no procedure-related complications. The report emphasizes that the one-stage procedure enabled internal biliary decompression without the need for external drainage catheters.
From the cases presented, the authors infer that one-stage percutaneous SEMS placement can be a safe and effective alternative to ERCP or EUS-guided approaches for patients with malignant biliary obstruction when those endoscopic options are not feasible. The technique avoids external catheter maintenance and theoretically may preserve patient quality of life by providing immediate internal drainage.
Limitations inherent to the source must be acknowledged: this is a small retrospective case series of five patients from a single institution. The source does not report longer-term follow-up data, stent patency durations, symptom relief metrics, comparative outcomes versus other approaches, or detailed peri-procedural laboratory results. These details were not reported in the source article and therefore cannot be inferred.
In this five-case series (April 2016–March 2025), a one-stage percutaneous technique using ultrasonographic guidance, a 19-gauge EVS™ needle, an 8-Fr dilator, and an Epic™ biliary self-expandable metal stent achieved technical success in all patients with malignant biliary obstruction who were unsuitable for ERCP. No procedure-related complications were reported. The authors conclude that, with careful patient selection, one-stage percutaneous SEMS placement offers rapid biliary decompression without external drainage and may improve quality of life for selected patients. Further larger and longer-term studies are required to define comparative effectiveness and durability; such data were not provided in the source.