Long-anchoring Stent Method as a Rescue Technique for Early Dysfunction of Covered Self-Expandable Metal Stents in Distal Malignant Biliary Obstruction: A Retrospective Case Series.

Objective: Covered self-expandable metal stents (SEMS) are widely used for treating distal malignant biliary obstruction (MBO). Severe SEMS angulation can cause stent dysfunction. Placement of a long double-pigtail plastic stent inside the SEMS (the "long-anchoring stent method") may straighten the angulated SEMS, thereby achieving effective biliary drainage. This study aimed to report the clinical outcomes of this novel method. Methods: We retrospectively analyzed 15 patients with distal MBO who underwent initial SEMS placement, subsequently experienced clinical failure or early recurrent biliary obstruction (RBO) within 90 days of initial placement, and underwent reintervention with the long-anchoring stent method between April 2020 and March 2025. Results: The median follow-up period was 307 days after the anchoring procedure. For the primary outcome, clinical success was achieved in all 5 patients with initial SEMS clinical failure and in all 15 patients overall. The median angle of the SEMS significantly straightened from 128.3° with the initial SEMS alone to 151.5° after anchoring stent placement ( Conclusion: The long-anchoring stent method is a simple, safe, and viable strategy for rescuing early dysfunction of covered SEMS, possibly in part through straightening of the SEMS angulation. Trial Registration: N/A.