Transpapillary Placement of a Multihole Covered Metal Stent Using a 5.9-Fr Delivery System Through a Forward-viewing Endoscope in Malignant Biliary Obstruction With Type I Duodenal Stenosis.
This case demonstrates a successful approach to biliary obstruction in a patient with duodenal stenosis using a forward-viewing endoscope and a slim delivery system.
Where it sits
this study against the rest of the aod-9604 corpusSummary and findings
This case report describes the successful transpapillary placement of a covered multihole self-expandable metal stent in a 66-year-old woman with stage IV pancreatic cancer and type I duodenal stenosis. The procedure utilized a 5.9-Fr delivery system through a forward-viewing endoscope, resulting in prompt resolution of cholangitis. No adverse events were reported.
Abstract
Concurrent malignant biliary obstruction (MBO) and type I duodenal stenosis represent a technically demanding scenario, as luminal narrowing frequently precludes passage of a standard side-viewing duodenoscope and limits conventional transpapillary drainage. Although endoscopic ultrasound-guided biliary drainage and percutaneous transhepatic biliary drainage are established alternative approaches, transpapillary drainage remains desirable when papillary access is achievable. We report a 66-year-old woman with stage IV pancreatic cancer who presented with obstructive jaundice and tumor-related type I duodenal stenosis (i.e., obstruction proximal to the papilla). A side-viewing duodenoscope failed to traverse the stenosis; however, a standard forward-viewing endoscope (GIF-Q260J) successfully reached the major papilla. Selective biliary cannulation was achieved, and a covered multihole self-expandable metal stent (SEMS) (HANAROSTENT Biliary Multihole Benefit) was deployed across the distal biliary stricture using an ultra-slim 5.9-Fr delivery system compatible with the 3.2-mm working channel. Stent placement was technically successful without adverse events, resulting in prompt resolution of cholangitis and enabling the initiation of second-line chemotherapy. This case highlights a practical and reproducible strategy that expands the therapeutic capability of standard forward-viewing endoscopes. The combination of a slim delivery system and covered multihole SEMS may provide a physiological alternative to non-transpapillary drainage in selected patients with MBO and advanced type I duodenal stenosis.
Background
The study addresses the challenge of managing concurrent malignant biliary obstruction and type I duodenal stenosis, conditions that complicate standard endoscopic procedures. Prior approaches include endoscopic ultrasound-guided biliary drainage and percutaneous transhepatic biliary drainage, but transpapillary drainage is preferred when feasible. This report presents a novel technique using a forward-viewing endoscope and a slim delivery system to facilitate stent placement in a difficult clinical scenario.
Methods
This is a case report involving a 66-year-old woman with stage IV pancreatic cancer. A forward-viewing endoscope was utilized to achieve selective biliary cannulation and deploy a covered multihole self-expandable metal stent. The procedure's success was evaluated based on technical success and resolution of symptoms.
Results
Stent placement was technically successful without adverse events. The procedure resulted in prompt resolution of cholangitis.
Interpretation
This case contributes to the literature by demonstrating an alternative method for biliary drainage in patients with complex anatomical challenges. However, the lack of a control group and the single-case nature limit the generalizability of these findings. The clinical significance of the resolution of cholangitis and subsequent chemotherapy initiation needs further investigation in larger studies.
Key findings
- Technical success in stent placement without adverse events.
- Prompt resolution of cholangitis enabling initiation of second-line chemotherapy.
Limitations
- Single case report with no control group.
- No statistical analysis provided.
- Limited generalizability due to small sample size.