A Minimally Invasive Solution for Malignant Duodenal Obstruction
A 52-year-old woman with gallbladder carcinoma and hilar stricture
developed a severe blockage in the duodenum, making it difficult for food to pass normally. She was evaluated by Dr. Animesh Gupta, Consultant Gastroenterologist, Ujala Cygnus Rainbow Hospital
.
The Challenge
Upper GI endoscopy revealed an infiltrative growth at the D1–D2 junction
, extending approximately 8 cm and causing a high-grade obstruction. The narrowing was severe enough that the endoscope could not be passed beyond the affected area.
The Procedure
To restore the passage, the medical team performed endoscopic and fluoroscopic-guided duodenal stenting
.
A guidewire was carefully passed across the narrowed segment and positioned in the proximal jejunum. The margins of the obstruction were then identified under fluoroscopy. A 14 cm self-expanding, partially uncovered enteral metal stent
was deployed across the obstructed area using combined endoscopic and fluoroscopic guidance.
Following deployment, the stent expanded properly and restored the openness of the duodenal passage, with satisfactory position and luminal patency confirmed.
Outcome
The procedure successfully restored luminal patency and provided palliative relief from the malignant obstruction
. The patient was advised to remain nil by mouth for two hours after the procedure, followed by clear liquids and a gradual transition to a soft, puréed and non-fibrous diet.
Key Takeaway
In patients with advanced cancer who develop malignant duodenal obstruction, endoscopic placement of a self-expanding metal stent can help restore the passage through the obstructed area and provide palliative relief
, as demonstrated in this case.
