Modified Endoscopic Biliary Stent as a Bridging Strategy in Complex Biliary Strictures

Abstract

Introduction. Endoscopic therapy represents the first-line strategy for the management of biliary strictures. However, strictures associated with altered biliary anatomy (particularly those located near the hepatic hilum or with angulated courses) may hamper the placement of conventional stents, especially when dedicated devices are unavailable.

Objective. To evaluate the technical feasibility and early clinical outcomes of using a modified endoscopic biliary stent as a temporary drainage strategy for the management of complex biliary strictures.

Materials and Methods. A retrospective study was conducted on a consecutive series of patients who underwent endoscopic retrograde cholangiopancreatography between 2020 and 2025. A hydrophilic percutaneous biliary drainage catheter, modified intraoperatively, was used when placement of a conventional plastic stent was not feasible or when such a device was unavailable. Technical and clinical success, bilirubin reduction, complications, stent migration, and device removal were analyzed.

Results. Fourteen patients were included (mean age, 52 ± 11 years; 35.7% female). Nine strictures were benign and five were malignant. Six cases (42.9%) were located ≤ 2 cm from the hepatic hilum. Both technical and clinical success rates were 100%, with a bilirubin decrease ≥ 1 mg/dL within 48 hours in all patients. No complications or stent migrations were observed. All devices were successfully removed endoscopically without difficulty.

Conclusion. The modified endoscopic biliary stent was technically feasible as a temporary drainage strategy for complex biliary strictures associated with altered anatomy and showed favorable preliminary clinical outcomes, particularly in settings with limited availability of dedicated devices.