Virk GS, Parsa NA, Tejada J, Mansoor MS, Hida S. Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis, a novel technique for malignant obstruction: A case report and review of literature. World J Gastrointest Endosc 2018; 10(9): 219-224 [PMID: 30283605 DOI: 10.4253/wjge.v10.i9.219]
Corresponding Author of This Article
Gurjiwan Singh Virk, MD, MSc, Doctor, Department of Medicine, Albany Medical Center, 47 New Scotland Ave, Albany, NY 12407, United States. virkg@amc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 219-224 Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.219
Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis, a novel technique for malignant obstruction: A case report and review of literature
Gurjiwan Singh Virk, Nour A Parsa, Juan Tejada, Muhammad Sohail Mansoor, Sven Hida
Gurjiwan Singh Virk, Department of Medicine, Albany Medical Center, Albany, NY 12047, United States
Nour A Parsa, Juan Tejada, Muhammad Sohail Mansoor, Sven Hida, Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
Author contributions: Tejada J, Parsa NA and Virk GS designed the report; Virk GS, Mansoor MS and Parsa NA performed the literature review; Virk GS and Parsa NA wrote the manuscript; Hida S and Tejada J reviewed the manuscript.
Informed consent statement: The patient involved in this study gave informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gurjiwan Singh Virk, MD, MSc, Doctor, Department of Medicine, Albany Medical Center, 47 New Scotland Ave, Albany, NY 12407, United States. virkg@amc.edu
Telephone: +1-248-3202562 Fax: +1-518-2626873
Received: March 22, 2018 Peer-review started: March 22, 2018 First decision: April 18, 2018 Revised: June 12, 2018 Accepted: June 25, 2018 Article in press: June 27, 2018 Published online: September 16, 2018
ARTICLE HIGHLIGHTS
Case characteristics
The patient with a bare metal stent (BMS) in the common bile duct (CBD) and self-expanding metal stent (SEMS) in the duodenum presented with worsening jaundice symptoms.
Clinical diagnosis
On esophagogastroduodenoscopy (EGD) patient was found to have gastric outlet obstruction (GOO) type II and worsening jaundice due mass obstructing the CBD.
Differential diagnosis
Pancreatic, duodenal or ampullary mass.
Laboratory diagnosis
Main laboratory testing for a biliary and duodenal obstructing mass would be a tissue biopsy obtained via endoscopic guided technique.
Imaging diagnosis
CT scan of the abdomen was used initially to find GOO followed by esophagogastroduodenoscopy (EGD).
Pathological diagnosis
Adenocarcinoma of the pancreas was found on biopsy.
Treatment
Covered metal stent (CMS) was placed into the previous BMS within the CBD through the already existing duodenal SEMS with relief of jaundice symptoms.
Related reports
To our knowledge other case reports don’t have concomitant BMS in the CBD and SEMS in the duodenum while getting CMS in the CBD stent.
Experiences and lessons
Even though accessing the papilla through an already existing duodenal SEMS and CBD BMS may be difficult, endoscopists can try cannulating the CBD to relieve patient’s obstructive biliary symptoms, and if need deploy another stent.
