Stent-in-stent placement of multi-hole metal stents (M2) for malignant hilar obstruction allows re-intervention as easily as with plastic stents

Fig. 2 Endoscopic technique for the removal of the MHSEMS.a The major papilla was visualized in a frontal view.b Biopsy forceps were used to grasp the luminal side of the MHSEMS.c The distal end of the MHSEMS was exposed into the duodenum, and a cannula and guidewire (GW) were inserted into the bile duct.d A GW was placed in the bile duct, and the MHSEMS was removed using biopsy forceps.e A fluoroscopic image with cannula and GW placed inside the MHSEMS. Fig. 3 Images of a new MHSEMS placed stent-in-stent.a Endoscopic image.b Fluoroscopic image.