Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis, a novel technique for malignant obstruction: A case report and review of literature

Abstract

For patients suffering from both biliary and duodenal obstruction, endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the treatment of choice. ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct (CBD). We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma. The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.

Keywords: Bare metal stent; Endoscopic retrograde cholangiopancreatography; Common bile duct; Self-expanding metal stent; Jaundice; Biliary obstruction; Gastric outlet obstruction

Core tip: Patients with gastric outlet obstruction from duodenal, ampullary or pancreatic malignancy frequently develop biliary obstruction. These patients usually undergo prophylactic biliary stent placement as the likelihood of developing biliary stricture or obstruction is very high. Here, we present a case of a patient who already had a duodenal and biliary stent which required placement of a covered metal stent into the existing common bile duct prosthesis to relieve his biliary obstructive symptoms.