Quadruple and quintuple transpapillary stenting without predilation for complex hilar biliary obstruction using a novel 7-Fr ultratapered plastic stent

Management of hilar biliary obstruction (HBO) often requires transpapillary multistenting; however, the insertion of more than three stents into severe hilar biliary strictures remains technically challenging, even after predilation [1]. Recently, a novel 7-Fr ultratapered plastic stent (Crane stent, SB-KAWASUMI, Kanagawa, Japan) has shown high insertability in endoscopic ultrasound-guided drainage procedures [2] [3] [4] [5]. Given their structural advantages, we used ultratapered stents for transpapillary multistenting in two challenging HBO cases ([Video 1]).