Short abstract
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Brief Explanation
A 43‐year‐old woman with advanced gastric cancer presented with gastric outlet obstruction. Duodenal stent (WallFlex duodenal soft 22 mm × 12 cm; Boston Scientific, Tokyo, Japan) was deployed to cover the stricture between the antrum and the second part of the duodenum. The stent did not expand fully because of the tight stricture even after balloon dilation. The stent became longer than expected which caused kinking at the stomach (Fig. 1).
Figure 1.
Kinking to the stomach wall because of insufficient stent expansion. (a) Abdominal X‐ray. (b) Endoscopic view.
Additional stent (ComVi pyloric/duodenal stent 20 mm × 12 cm; Taewoong Medical, Gyeonggi‐do, Korea) was inserted 4 days after the first intervention to support stent expansion at the stricture (Video S1). Detachable snare (Endo‐Loop; Olympus Medical, Tokyo, Japan) with a 20‐mm opening diameter was also used to adjust the initial stent. It was grasped by forceps and placed in the stomach outside the endoscope (CF‐HQ290I; Olympus Medical). It was fixed by clips at two places (the proximal end and the body) of the duodenal stent. Duodenal stent was folded by squeezing the bound detachable snare and the stent orifice was directed into the lumen of the stomach (Fig. 2). Additional stent expanded fully at the stricture 2 days after the second intervention. The patient began to eat and could take solid foods for 2 months until deterioration of general condition.
Figure 2.
Adjusting the length and direction of the redundant duodenal stent using a detachable snare and endoclips. (a) Detachable snare was fixed by clips at two places of the duodenal stent. (b) Duodenal stent was folded by squeezing the bound detachable snare. (c) Stent orifice was directed into the lumen of the stomach. (d) Duodenal stent was successfully adjusted using a detachable snare.
Duodenal stent placement is carried out for the treatment of gastric outlet obstruction.1, 2 Stent with high shortening ratio is deployed longer than expected when it does not expand enough. Stent kink sometimes occurs especially when a longer stent is used. Additional stent placement is one way to rescue an insufficient stent expansion.3 Trimming the redundant stent using argon plasma coagulation4 or loop cutter5 is also effective to adjust the length itself. However, these methods could not correct the direction of the duodenal stent. Our method is useful to optimize both the length and direction of a duodenal stent.
Authors declare no conflicts of interest for this article.
Supporting information
Video S1 Adjusting the length and direction of the redundant duodenal stent using a detachable snare and endoclips.
References
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Associated Data
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Supplementary Materials
Video S1 Adjusting the length and direction of the redundant duodenal stent using a detachable snare and endoclips.