Figure 1. a–f.

A 59-year-old patient with metastatic duodenal cancer. Preprocedural axial abdominal computed tomography (CT) (a) shows malignant stricture at the distal duodenum (arrow). Fluoroscopic image (b) demonstrates failure of endoscopic and fluoroscopic transoral route to traverse the stricture. Fluoroscopic images (c–e) obtained during transgastric metallic stenting show traversing malignant stricture (arrow) with a catheter (c) and deployment of metallic stent over an exchanged wire (d). A gastrostomy catheter was left at the end of the procedure (e). Axial abdominal CT (f) performed 35 weeks after procedure shows patent stent without GDO.