Dear colleagues!

We are glad to present you a video report on the double biliary and duodenal stents placement in case of obstructing tumor of the pancreatic head.

Stenting was performed by the duodenal stent Endo-Flex GmbH (Germany) and biliary stent Endo Stars LLC (Russia). 

Treating physician – doctor Rinchinov Vyacheslav Bazarzhapovich. 

Patient history: 65-year old patient was hospitalized to the clinic with the obstructive jaundice and suspected mass lesion on the pancreatic head. On 25.08.2015, ERCP was peformed. Biliary stenting by plastic stent 7Fr. Intraduct brush biopsy. Cytology dd. 25.08.2015 – adenocarcinome.

Then the patient was referred to N.N. Blokhin’s Russian Cancer Research Center for supplementary examination and making solution about the necessity of the surgical treatment.  The case was recognized as unresectable, and the patient was discharged with the diagnosis:  cancer of the pancreatic head Т2N1M1 of the IV degree with the recommendation to undergo chemotherapy at the healthcare institution according to the place of residence.  Then the patient underwent 3 courses of maintenance chemotherapy in the oncological dispensary.   

At present, the patient was admitted with the manifestations of the progressing dysphagia, occasional body temperature increase up to 38˚С, bilirubin increase in blood up to 42 µm/L. Gastroscopic study showed subcompensated stenosis of the superior duodenum flexure. After preliminary discussion, it was resolved to perform double stenting of the bile ducts and duodenum by self-expanding nitinol stents.

Peculiarities of such stenting were:

-  Initial doubts concerning duodenoscope guiding through the stenosis area of the superior duodenum flexure

-  absence of gastroscope with a wide aperture for pyloroduodenal stenting.

Main stages:

1)      initial photo made in August, 2015,

2)      Gastroscopic study before ERCP,

3)      attempt to guide duodenoscope into duodenum

4)      balloon dilatation of stenosis with duodenoscope guidance into duodenum.

5)      removal of the plastic biliary stent

6)      ERCP. Stent placement in the bile ducts

7)      removal of the plastic stent from duodenum

8)     Conductor guidance into small intestine through the gastroscope

9)      pyloroduodenal stent is guided into stomach through the conductor

10)  Gastroscope is guided in parallel and stent is placed in the duodenum  stenosis area under visual  X-ray control.

11)   Stent opening in duodenum.

12)   X-Ray control in 24 hours – no data about stents migration.

Treatment institution - Autonomous Public Health Care Institution "Republican Clinical Hospital named after N.A. Semashko”, Ulan-Ude, the Republic of Buryatiya