---
title: "One-Stage Percutaneous SEMS Placement for Malignant Biliary Obstruction: Five-Case Series"
id: "pubmed-42669946"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42669946"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42669946/"
published_at: "2026-09-20T00:00:00.000Z"
evidence_level: "Case Reports"
license: "CC-BY-NC-4.0 / Informational Use"
---
# One-Stage Percutaneous SEMS Placement for Malignant Biliary Obstruction: Five-Case Series
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42669946
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42669946/)
- **Published At:** 2026-09-20T00:00:00.000Z
- **Evidence Rating:** Case Reports
## Executive GIST (TL;DR)
- This retrospective five-case series (April 2016–March 2025) evaluated a **one-stage percutaneous** approach to place **self-expandable metal stents (SEMS)** for malignant biliary obstruction in patients unsuitable for ERCP or endoscopic ultrasound-guided drainage. - Five patients (four women, one man; median age 68) at Tokai University Hospital underwent the procedure; underlying malignancies included pancreatic head carcinoma, recurrent cholangiocarcinoma (postoperative) in two patients, recurrent gallbladder carcinoma (postoperative) in one, and postoperative gastric carcinoma with peritoneal dissemination in one. - ERCP was not feasible for varied reasons: duodenal stenosis, choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy with failed cannulation, inflammation precluding laparoscopic SSPPD attempt, and Roux-en-Y reconstruction. - The percutaneous technique used ultrasonographic guidance with a 19-gauge EVS™ needle, guidewire exchange, tract dilation with an 8-Fr dilator, and deployment of an Epic™ biliary SEMS in a single-stage session. - Clinical context included three patients with moderate cholangitis and two with mild cholangitis as classified by the Tokyo Guidelines 2018. - Technical success was achieved in all five patients; no procedure-related complications were reported in the series. - Authors conclude that **one-stage percutaneous SEMS placement** is a safe, effective option to achieve rapid biliary decompression without external drainage and may improve quality of life when ERCP or EUS-guided drainage are not feasible, with the caveat of careful case selection.
## Clinical Analysis & Structured Key Points
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Tokai J Exp Clin Med. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Tokai J Exp Clin Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tokai+J+Exp+Clin+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Tokai+J+Exp+Clin+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42669946/) . 2026 Sep 20;51(3):142-146. ### Authors [Hideki Izumi](https://pubmed.ncbi.nlm.nih.gov/?term=Izumi+H&cauthor_id=42669946)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669946/#short-view-affiliation-1 "Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo 192-0032, Japan. h_izumy@yahoo.co.jp."), [Junichi Kaneko](https://pubmed.ncbi.nlm.nih.gov/?term=Kaneko+J&cauthor_id=42669946), [Toshihito Ogasawara](https://pubmed.ncbi.nlm.nih.gov/?term=Ogasawara+T&cauthor_id=42669946), [Masaya Mukai](https://pubmed.ncbi.nlm.nih.gov/?term=Mukai+M&cauthor_id=42669946), [Hiroyasu Makuuchi](https://pubmed.ncbi.nlm.nih.gov/?term=Makuuchi+H&cauthor_id=42669946) ### Affiliation * 1 Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo 192-0032, Japan. h_izumy@yahoo.co.jp. * PMID: **42669946** Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** Endoscopic retrograde cholangiopancreatography (ERCP) with self-expandable metal stent (SEMS) placement is the standard treatment for malignant biliary obstruction; however, it may not be feasible in cases of duodenal invasion, altered anatomy, or failed cannulation. Although percutaneous transhepatic biliary drainage is a reliable alternative, it is associated with external catheter-related complications and impaired quality of life. Recently, a one-stage percutaneous SEMS placement procedure has been proposed to overcome these limitations. **Methods:** We retrospectively reviewed five patients (four women and one man; median age, 68 years) with malignant biliary obstruction who underwent one-stage percutaneous SEMS placement between April 2016 and March 2025 at the Tokai University Hospital. The procedures were performed under ultrasonographic guidance using a 19-gauge EVS™ needle, followed by guidewire exchange, tract dilation with an 8-Fr dilator, and deployment of an Epic™ biliary SEMS. Technical and clinical success and procedure-related complications were evaluated. **Results:** Herein, the underlying diseases included pancreatic head carcinoma (n = 1), postoperative cholangiocarcinoma with lymph node recurrence (n = 2), postoperative gallbladder carcinoma with lymph node recurrence (n = 1), and postoperative gastric carcinoma with peritoneal dissemination (n = 1). ERCP failure was due to the following reasons: duodenal stenosis, choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with cannulation failure, laparoscopic SSPPD not attempted due to inflammation, and Roux-en-Y reconstruction. Three and two patients presented with moderate and mild cholangitis, respectively, as per the Tokyo Guidelines 2018. Technical success was achieved in all patients. No procedure-related complications occurred. **Conclusion:** One-stage percutaneous SEMS placement is a safe and effective option for treating malignant biliary obstruction in patients unsuitable for ERCP or endoscopic ultrasound-guided biliary drainage. With careful case selection, this approach enables rapid biliary decompression without external drainage and may improve the patient's quality of life. 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