Description:
A 56 year old man with malignant duodenal obstruction presents with recurrent nausea and vomiting. The endoscope is not able to be passed through the existing duodenal stent. Both the duodenal stent and the previously placed biliary stent can be seen. A standard biliary extraction balloon is passed through the narrowed lumen of the previously placed stent. As contrast is injected, tight stenosis is seen within the stent just distal to the balloon. The balloon is pulled through the stent with a great amount of resistance. The guidewire is left in place within the proximal jejunum. The balloon is completely deflated and removed from the stent, and the balloon catheter is exchanged as the guidewire is left in place. Then an uncovered 22 x 90 mm Wallflex™ enteral stent is slowly advanced over the guidewire through the stricture in the existing duodenal stent. Once the new stent is completely inserted through the old stent, stent deployment begins. As the stent is deployed from its catheter, the distal end can be seen opening first. Finally, the proximal end is slowly deployed, the delivery catheter is removed, and the guidewire is pulled as bile is seen refluxing back into the stomach. Fluoroscopically, the new stent can be seen resting within the old stent. The balloon catheter is then reinserted through the lumen of the new stent, and as it's inflated and pulled back there is little resistance as the balloon is pulled through the newly placed duodenal stent. Now bile freely flows back through the stent into the gastric lumen. Final fluoroscopic views show adequate luminal patency.
Contributed By:
Jonathan Buscaglia, MD, Stony Brook University Medical Center
Parantap Gupta, MD, Stony Brook University Medical Center
