No stent migration was occurred in inoperable patients. Stent obstruction in inoperable patients was developed in 15.9% (7/44) during follow up period. Conclusion: The modified fully covered SEMS may be useful to prevent stent migration in patients with distal malignant biliary obstruction. Long-term STA-9090 mouse follow up and prospective comparative studies were demanded. Key Word(s): 1. distal malignant biliary obstruction; 2. covered self-expandable metallic stent Presenting Author: SOO KYUNG PARK Additional Authors: JONG HO MOON, HYUN JONG CHOI, YUN NAH

LEE, TAE HOON LEE, SANG WOO CHA, YOUNG DEOK CHO, SANG HEUM PARK, SUN JOO KIM Corresponding Author: SOO-KYUNG PARK Affiliations: Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University School of Medicine, Soonchunhyang University

School of Medicine, Soonchunhyang University School of Medicine, SoonChunHyang University School of Medicine, Soonchunhyang University School of Medicine Objective: Endoscopic bilateral metallic stenting has been introduced as feasible and effective palliative modality in patients with inoperable hilar malignant biliary strictures (MBS). However, repetitive endoscopic revision of occluded bilateral metallic stents may be challenging. The aim of this study was to GSK-3 signaling pathway evaluate the feasibility and efficacy of repetitive endoscopic revision after first endoscopic revision for hilar MBS previously managed by bilateral stent-in-stent placement with cross-wired metallic stents. Methods: Total 6 patients (5 cholangiocarcinoma and one gallbladder cancer) who had previously managed by bilateral stent-in-stent placement with cross-wired metallic

stents (BONASTENT-M Hilar, Standard Sci Tech., Seoul, Korea) were required repetitive biliary reintervention because of stent occlusion after first endoscopic revision during follow up. Results: Total 19 repetitive endoscopic revision were performed. The mean number of repetitive endoscopic revision for each patient was 3.2 (range 1–8). Technical and clinical success rate of repetitive endoscopic revision after first endoscopic revision was 100.0% (19/19) and 78.9% (15/19), respectively. Bilateral revision was performed in 8 (42.1%) MCE endoscopic sessions. Early and late complication rate was 15.8% (3/19, cholangitis; 1, pancreatits; 2) and 21.1% (4/19, liver abscess; 4), respectively. And, stent occlusion rate was 68.4% (13/19). Mean stent patency period was 75 days (20–265), and became shorter than when first stenting (216 days, 43–481) and first revision (126 days, 34–316) (p = 0.006). Conclusion: Repetitive endoscopic revision for hilar MBS previously managed by bilateral metallic stenting was feasible. Cross-wired metallic stents for hilar MBS may facilitate repetitive endoscopic revision after stent occlusion. Key Word(s): 1. Hilar malignant biliary stricture; 2.