Outcome and follow-up
ERCP-related complications were not observed, and the patient was discharged on the 9th day of admission, with good progress.
In January 2020, the plastic stent in the bile duct was replaced with a self-expandable metallic stent (SEMS) (WallFlexTMBiliary RX UNCOVERED 10×80 mm) (Fig. 6). Cholecystitis developed as a complication, which was resolved with percutaneous transhepatic gallbladder aspiration and antibacterial therapy.
After this treatment, the patient continued chemotherapy as an outpatient but was readmitted in July 2020 due to worsening jaundice. A CECT scan of the abdomen showed soft tissue shadows inside the SEMS, suggesting the possibility of tumor invasion into the SEMS. ERCP was performed, and a plastic stent was therefore placed into the SEMS (Fig. 7). Jaundice improved, and the patient was discharged with no complications.
In August of the same year, the patient was readmitted to the hospital for worsening jaundice. ERCP was performed, and the plastic stent, which was suspected to be obstructed, was removed. After the stenosis was dilated with an 8.5 Fr dilation catheter, an alternative plastic stent was placed into the SEMS.
In September of the same year, the jaundice worsened again, and the patient was readmitted for further treatment. ERCP was performed and the plastic stent placed in the SEMS was removed. Severe stenosis was observed in the SEMS due to tumor invasion, and an additional SEMS (HANAROSTNT® Benefit Biliary covered 8 mm × 80 mm) was placed in the stent-in-stent configuration (Fig. 8).
Thereafter, outpatient chemotherapy was continued. Stent occlusion did not re-occur, and jaundice did not worsen. However, in December of the same year, her general condition deteriorated due to multiple liver metastases of breast cancer. The patient received palliative treatment and died 358 days after the initial hospitalization.