This patient was a 65 year old lady who had developed duodenal luminal stenosis after healing of a large duodenal ulcer. On endoscopy, the duodenal lumen was reduced to a pinhole just beyond the bulb (A: white arrow). We were using an Olympus dual channel scope. We decided to use a straight ERCP cannula to try and go through the stricture (B) but even that couldn't go through. We were however able to get a guidewire across the stricture after engaging it with the cannula (C: white arrows). This was followed by dilatation of the strictured track with graduated dilatation catheters (D1, D2 & D3: white arrows). A stent assembly was then placed across the stricture (E: white arrows) and an uncovered self expanding metallic stent of 20mm diameter and 130mm length was deployed (F1 & F2: white arrows. Red arrows show the "waist" of the stent due to the strictured area. G1, G2 & G3: the stent going through expansion).
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