[A patient with bile duct cancer who showed rapid obstruction after insertion of a non covered stent, but in this case obtained a stent opening and better QOL after reinsertion of a covered stent].

A 73-year-old man is presented with jaundice. Dynamic CT showed a papillary mass in the common bile duct. Percutaneous transhepatic cholangiography revealed a filling defect in the middle common bile duct. Poorly differentiated adenocarcinoma was demonstrated from a papillary mass in the common bile duct by biopsy specimens obtained under p. ercutaneous transhepatic cholangioscopy. Based on these findings, upper to middle bile duct cancer was diagnosed. An unresectable tumor was defined by involving the main portal vein and common hepatic artery at surgical exploration. A non-covered expandable metallic stent was placed 8 days after the operation. However, since contrast radiography showed tumor protrusion in the stent next day after the insertion, a covered stent was placed. Stent obstruction did not occur, and the patient was discharged from the hospital with a good quality of life. A covered stent can be more potentially and clinically effective than a non-covered stent especially for a papillary tumor in the bile duct.