This 70 year old gentleman had previously undergone placement of a metallic biliary stent last year for an ampullary tumor. He was subsequently lost to follow up and had only now presented with gastric outlet obstructive symptoms. A swallowed contrast study (A) clearly showed the problem. The previously placed stent was outlined (A: white arrows) along with the intrahepatic biliary channel (A: green arrows). The stricture was also seen as a thin structured segment in the second part of the duodenum (A: red arrow). On endoscopy, the affected area was seen with almost complete luminal obstruction (B: white arrow). We placed a biliary cannulation catheter across the stricture followed by contrast injection which outlined the extent of the stricture (C: red arrowheads) and the unaffected bowel segment beyond the stricture (C: blue arrow). The biliary stent was also seen (C: white arrowheads). A guidewire was then placed across the stricture (D: white arrows) followed by a stent assembly (E: black arrows). A 12 cm long stent of 20 mm diameter was then deployed (F1 & F2 : black arrows show the stent assembly. White arrowheads show the deployed portion of the stent . Red arrowheads show the distal and middle radiographic markers of the stent. F3: Fully deployed stent. Stent outlined with white arrowheads. Red arrowheads showing the radiographic stent markers. Blue arrow showing the previously injected contrast in the lumen of the distal portion of the stent. G1 & G2: The stent as seen by the endoscope: white arrows. Compare with B).
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