Fig. 6. Hilar liver metastasis of pancreatic cancer. (A) The cholangiogram shows hilar biliary obstruction with separation between each segment duct (right anterior duct [RAD], right posterior duct [RPD], and left hepatic duct [LHD]). Endoscopic self-expandable metallic stents placement was performed previously. (B) The first stent delivery system was inserted from the LHD into the RAD, and the second stent delivery system was inserted from the LHD into the RPD. (C) The proximal edge of the first stent (8-mm diameter, 40-mm length, Zilver stent; COOK Medical) was deployed at the bifurcation of the right hepatic duct (arrowhead). A third stent delivery system was inserted from the LHD into the common bile duct before the second stent deployment (arrow). (D) The second stent (8-mm diameter, 80-mm length, Zilver stent) was placed overlapping with the proximal edge of the first stent. (E, F) The third stent (8-mm diameter, 80-mm length, Zilver stent) was placed overlapping with the proximal edge of the second stent.
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