Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
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:
Correspondence to: Gurjiwan Singh Virk, MD, MSc, Doctor, Department of Medicine, Albany Medical Center, 47 New Scotland Ave, Albany, NY 12407, United States.
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
Processing time: 179 Days and 13.5 Hours
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.


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.