Figure 4a. Duodenal stent placement via a gastrostomy tract in an 85-year-old patient with pancreatic cancer invading the duodenum. Percutaneous gastrostomy was performed for enteral feeding, but the patient continued to experience symptoms of gastric outlet obstruction. (a) Anteroposterior radiograph shows an introducer sheath that has been passed through the gastrostomy tract. The guide wire was passed through a stricture in the third portion of the duodenum (arrowheads). (b) Radiograph shows the position of the stent delivery system (arrowheads). Note the metallic markers placed on the patient’s skin to mark the location of the stricture. (c) Anteroposterior radiograph obtained after stent deployment shows a new gastrostomy tube (arrowheads). Note the position of the duodenal stent (arrow), with passage of contrast material into the jejunum.