Stent occlusion remains a major problem in biliary stenting, and emergency treatment is required. Various second stents, such as plastic stent (PS), uncovered self-expanding metallic stent (SEMS), and covered SEMS, are selected considering primary inserted stent, causes of stent occlusion, and prognosis of the patients. If large amounts of debris or food residue exist in the occluded stent or bile duct, we should remove them before second stent insertion for longer patency. Rate of reocclusion, stent patency, and survival time are not significantly different among PS, uncovered SEMS, and covered SEMS in meta-analysis. Re-intervention of bilateral placement of uncovered SEMS in malignant hilar biliary obstruction (MHBO) is relatively difficult, especially in patients with partial stent in stent placement. Loop technique of guidewire, use of bendable catheter, balloon dilation of stent mesh, and the use of thin delivery system should be attempted for successful re-intervention.
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