Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Jun 14, 2010; 16(22): 2828-2831
Published online Jun 14, 2010. doi: 10.3748/wjg.v16.i22.2828
Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer
Iruru Maetani, Tomoko Nambu, Shigefumi Omuta, Takeo Ukita, Hiroaki Shigoka
Iruru Maetani, Tomoko Nambu, Shigefumi Omuta, Takeo Ukita, Hiroaki Shigoka, Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
Author contributions: Maetani I contributed to the conception, designed the study, drafted the article, and treated the patients; Nambu T drafted the article and was involved in the treatment of patients; Omuta S treated the patients and collected the data; Ukita T collect the data; Shigoka H made the critical revision of the paper and collected the data.
Correspondence to: Iruru Maetani, MD, Division of Gastroenterology, Department of Internal Medicine,Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Telephone: +81-3-34681251 Fax: +81-3-54650210
Received: March 15, 2010
Revised: April 16, 2010
Accepted: April 23, 2010
Published online: June 14, 2010

Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer.

Keywords: Biliary obstruction, Duodenal obstruction, Pancreatic cancer, Self-expandable metallic stent, Stent placement, Thin forward-viewing endoscope