Practical guide to duodenal stenting for gastric outlet obstruction: Clinical outcomes, selection criteria, placement techniques, and management strategies

Figure 1 Half-and-half technique. A: The technique begins by advancing the endoscope towards the stricture site, injecting contrast medium through a catheter, to confirm the extent of the stricture. At this stage, a 1-2 cm gap between the proximal side of the stricture and the endoscope can facilitate a measurement; B: The endoscope is advanced closer to the stricture to enhance scope stability. Since the endoscope tip is positioned at the proximal side of the stricture, marking clips are unnecessary; C: The stent delivery system is then advanced, and the central marker is aligned with the stricture. The stent placement is initiated with approximately half of the stent remaining inside the endoscope channel. The stent is partially deployed within the endoscope but is not fully expanded at this stage. The stent is then fully released by simultaneously pushing out the delivery system while withdrawing the endoscope, ensuring that the stent remains in its intended position.