Endoscopic Deployment of Multiple JOSTENT SelfX Is Effective and Safe in Treatment of Malignant Hilar Biliary Strictures  Hirofumi Kawamoto, Koichiro Tsutsumi, Ryo Harada, Masakuni Fujii, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Kohsaku Sakaguchi  Clinical Gastroenterology and Hepatology  Volume 6, Issue 4, Pages 401-408 (April 2008) DOI: 10.1016/j.cgh.2007.12.036 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 Picture of the JOSTENT SelfX. Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 2 Procedure for partial stent-in-stent deployment. Patient had type II stenosis, caused by cholangiocarcinoma. After passing a guidewire into the left hepatic duct, the right hepatic duct was sought with another guidewire (A). After dilating the stenotic lesion with a balloon dilator, the first JOSTENT SelfX was deployed from the left hepatic duct to the common bile duct. In (B), the guidewire in the right hepatic duct existed outside of the initially deployed JOSTENT SelfX, so that finding the branching point of the right hepatic duct with a guidewire through the mesh in the first JOSTENT SelfX was easy to achieve by using it as a landmark for branching. After passing a guidewire through the mesh into the right hepatic duct, the second JOSTENT SelfX was deployed in the partial stent-in-stent procedure (C). Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 3 This patient had cholangiocarcinoma in the left lobe of the liver. Because the liver parenchyma in the left lobe was replaced by the tumor, there was no necessity for stent deployment in the left hepatic duct (A). Right anterior and posterior hepatic ducts were stenosed separately by the tumor (B). Therefore, 2 JOSTENT SelfX stents were deployed in both right hepatic ducts via the partial stent-in-stent procedure (C). Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 4 Three-branched partial stent-in-stent procedure with JOSTENT SelfX stents. Patient had cholangiocarcinoma with type IV hilar stricture (A). This patient had 3 JOSTENT SelfX stents inserted into the left lateral, right anterior, and right posterior segments, respectively (B). Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 5 Four-branched partial stent-in-stent procedure with JOSTENT SelfX stents. Patient had cholangiocarcinoma with type IV hilar stricture (A). This patient had 4 JOSTENT SelfX stents inserted into the left lateral, S5 and S8 of the right anterior, and right posterior segments, respectively (B). Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 6 Cumulative patency curve of the JOSTENT SelfX, assessed via the Kaplan-Meier method. Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 7 Kaplan-Meier curve of overall survival after multiple deployment of JOSTENT SelfX. Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions

Figure 8 Kaplan-Meier curve of survival in patients receiving chemotherapy after multiple deployment of the JOSTENT SelfX. Clinical Gastroenterology and Hepatology 2008 6, 401-408DOI: (10.1016/j.cgh.2007.12.036) Copyright © 2008 AGA Institute Terms and Conditions