A case of endoscopic placement of a covered duodenal stent for the obstruction of the uncovered duodenal stent

Abstract

We report a case of endoscopic placement of a covered duodenal stent for the obstruction of the uncovered duodenal stent. An 80-year-old woman was admitted with a chief complaint of vomiting. Abdominal contrast-enhanced computed tomography revealed local recurrent breast cancer lesions in the right breast, multiple bone metastases in thoracolumbar spine, and stenosis of the horizontal duodenum due to peritoneal dissemination. An uncovered duodenal stent was placed to reduce the risk of pancreatitis due to compression of the duodenal Vater papilla. 23 days later, she was admitted with vomiting and was diagnosed with stent obstruction due to tumor growth in the stent. She was willing to eat, and a 12-cm-long covered duodenal stent (diameter, 22 mm) was placed using the stent-in-stent technique. The patient has not experienced re-occlusion or stent migration at last follow-up. The choice between uncovered and covered stents remains controversial. Future studies should evaluate approaches to overcome tumor growth in the stent and stent migration to improve stent patency.