The “Stent through Stent Technique” for Hilar Malignant Stenosis Complicated with Common Bile Duct Calculi

: We report here on a patient who had a Bismuth type III hilar malignant stenosis and a primary common bile duct calculi which was an added complication. This stenosis was effectively treated by a “stent through stent technique”, that consisted of two metal stents braided together by expanding a wire gap in the mesh of the first stent and inserting the last one through this former dilated wire gap, achieving bilateral biliary drainage. The primary common bile duct stone was treated by percutaneous cholangioscopically-guided electrohydraulic lithotripsy. This technique might be applied on a large series of patients with hilar malignant stenosis and in the case of the uncommon association with primary common bile duct calculi electrohydraulic lithotripsy using the percutaneous approach should be considered as a good approach.