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Gastroduodenal Stent Placement: Current Status¹

¹ From the Department of Radiology, Louisiana State University Health Science Center, 1542 Tulane Ave, New Orleans, LA 70112. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received March 11, 2004; revision requested March 31 and received May 10; accepted May 11. All authors have no financial relationships to disclose. Address correspondence to J.E.L. (e-mail: jloper@lsuhsc.edu).

View larger version (57K): [in a new window]   Figure 1.  Photograph shows the enteral Wallstent (arrow) with a 10-F delivery system.

View larger version (118K): [in a new window]   Figure 2a.  Endoscopic gastroduodenal stent placement. (a) Photograph obtained during endoscopy of the upper gastrointestinal tract shows severe narrowing of the antrum (arrow). (b) Anteroposterior radiograph shows the endoscope passing distal to the lesion. (c) Anteroposterior radiograph shows a partially expanded Song duodenal stent (Stentech, Seoul, Korea) (arrow), which is being deployed under direct endoscopic-fluoroscopic guidance. (d, e) Photographs obtained during endoscopy of the upper gastrointestinal tract performed after gastroduodenal stent placement show a widely patent intestinal lumen (d) and the proximal end of the stent protruding into the stomach (arrow in e).

View larger version (139K): [in a new window]   Figure 2b.  Endoscopic gastroduodenal stent placement. (a) Photograph obtained during endoscopy of the upper gastrointestinal tract shows severe narrowing of the antrum (arrow). (b) Anteroposterior radiograph shows the endoscope passing distal to the lesion. (c) Anteroposterior radiograph shows a partially expanded Song duodenal stent (Stentech, Seoul, Korea) (arrow), which is being deployed under direct endoscopic-fluoroscopic guidance. (d, e) Photographs obtained during endoscopy of the upper gastrointestinal tract performed after gastroduodenal stent placement show a widely patent intestinal lumen (d) and the proximal end of the stent protruding into the stomach (arrow in e).

View larger version (132K): [in a new window]   Figure 2c.  Endoscopic gastroduodenal stent placement. (a) Photograph obtained during endoscopy of the upper gastrointestinal tract shows severe narrowing of the antrum (arrow). (b) Anteroposterior radiograph shows the endoscope passing distal to the lesion. (c) Anteroposterior radiograph shows a partially expanded Song duodenal stent (Stentech, Seoul, Korea) (arrow), which is being deployed under direct endoscopic-fluoroscopic guidance. (d, e) Photographs obtained during endoscopy of the upper gastrointestinal tract performed after gastroduodenal stent placement show a widely patent intestinal lumen (d) and the proximal end of the stent protruding into the stomach (arrow in e).

View larger version (138K): [in a new window]   Figure 2d.  Endoscopic gastroduodenal stent placement. (a) Photograph obtained during endoscopy of the upper gastrointestinal tract shows severe narrowing of the antrum (arrow). (b) Anteroposterior radiograph shows the endoscope passing distal to the lesion. (c) Anteroposterior radiograph shows a partially expanded Song duodenal stent (Stentech, Seoul, Korea) (arrow), which is being deployed under direct endoscopic-fluoroscopic guidance. (d, e) Photographs obtained during endoscopy of the upper gastrointestinal tract performed after gastroduodenal stent placement show a widely patent intestinal lumen (d) and the proximal end of the stent protruding into the stomach (arrow in e).

View larger version (115K): [in a new window]   Figure 2e.  Endoscopic gastroduodenal stent placement. (a) Photograph obtained during endoscopy of the upper gastrointestinal tract shows severe narrowing of the antrum (arrow). (b) Anteroposterior radiograph shows the endoscope passing distal to the lesion. (c) Anteroposterior radiograph shows a partially expanded Song duodenal stent (Stentech, Seoul, Korea) (arrow), which is being deployed under direct endoscopic-fluoroscopic guidance. (d, e) Photographs obtained during endoscopy of the upper gastrointestinal tract performed after gastroduodenal stent placement show a widely patent intestinal lumen (d) and the proximal end of the stent protruding into the stomach (arrow in e).

View larger version (145K): [in a new window]   Figure 3a.  Technique for gastroduodenal stent placement. (a) Anteroposterior radiograph shows an angiographic catheter crossing a stricture in the antrum (arrows). The stricture is localized with contrast material injected through the catheter. (b) Anteroposterior radiograph shows a superstiff guide wire (arrow) that has been advanced into the jejunum. The delivery system for the stent (arrowheads) is advanced over the guide wire and centered in the stricture. (c) Anteroposterior radiograph obtained after stent deployment shows a partially expanded stent (arrows). Note that the center of the stent is compressed by the tumor. (d) Anteroposterior radiograph shows a 10-F introducer sheath (arrow). Contrast material is injected through the sheath to assess the position of the stent. (e) Anteroposterior radiograph obtained 1 day after the procedure shows almost complete expansion of the stent. Note the decompression of the stomach.

View larger version (149K): [in a new window]   Figure 3b.  Technique for gastroduodenal stent placement. (a) Anteroposterior radiograph shows an angiographic catheter crossing a stricture in the antrum (arrows). The stricture is localized with contrast material injected through the catheter. (b) Anteroposterior radiograph shows a superstiff guide wire (arrow) that has been advanced into the jejunum. The delivery system for the stent (arrowheads) is advanced over the guide wire and centered in the stricture. (c) Anteroposterior radiograph obtained after stent deployment shows a partially expanded stent (arrows). Note that the center of the stent is compressed by the tumor. (d) Anteroposterior radiograph shows a 10-F introducer sheath (arrow). Contrast material is injected through the sheath to assess the position of the stent. (e) Anteroposterior radiograph obtained 1 day after the procedure shows almost complete expansion of the stent. Note the decompression of the stomach.

View larger version (150K): [in a new window]   Figure 3c.  Technique for gastroduodenal stent placement. (a) Anteroposterior radiograph shows an angiographic catheter crossing a stricture in the antrum (arrows). The stricture is localized with contrast material injected through the catheter. (b) Anteroposterior radiograph shows a superstiff guide wire (arrow) that has been advanced into the jejunum. The delivery system for the stent (arrowheads) is advanced over the guide wire and centered in the stricture. (c) Anteroposterior radiograph obtained after stent deployment shows a partially expanded stent (arrows). Note that the center of the stent is compressed by the tumor. (d) Anteroposterior radiograph shows a 10-F introducer sheath (arrow). Contrast material is injected through the sheath to assess the position of the stent. (e) Anteroposterior radiograph obtained 1 day after the procedure shows almost complete expansion of the stent. Note the decompression of the stomach.

View larger version (152K): [in a new window]   Figure 3d.  Technique for gastroduodenal stent placement. (a) Anteroposterior radiograph shows an angiographic catheter crossing a stricture in the antrum (arrows). The stricture is localized with contrast material injected through the catheter. (b) Anteroposterior radiograph shows a superstiff guide wire (arrow) that has been advanced into the jejunum. The delivery system for the stent (arrowheads) is advanced over the guide wire and centered in the stricture. (c) Anteroposterior radiograph obtained after stent deployment shows a partially expanded stent (arrows). Note that the center of the stent is compressed by the tumor. (d) Anteroposterior radiograph shows a 10-F introducer sheath (arrow). Contrast material is injected through the sheath to assess the position of the stent. (e) Anteroposterior radiograph obtained 1 day after the procedure shows almost complete expansion of the stent. Note the decompression of the stomach.

View larger version (163K): [in a new window]   Figure 3e.  Technique for gastroduodenal stent placement. (a) Anteroposterior radiograph shows an angiographic catheter crossing a stricture in the antrum (arrows). The stricture is localized with contrast material injected through the catheter. (b) Anteroposterior radiograph shows a superstiff guide wire (arrow) that has been advanced into the jejunum. The delivery system for the stent (arrowheads) is advanced over the guide wire and centered in the stricture. (c) Anteroposterior radiograph obtained after stent deployment shows a partially expanded stent (arrows). Note that the center of the stent is compressed by the tumor. (d) Anteroposterior radiograph shows a 10-F introducer sheath (arrow). Contrast material is injected through the sheath to assess the position of the stent. (e) Anteroposterior radiograph obtained 1 day after the procedure shows almost complete expansion of the stent. Note the decompression of the stomach.

View larger version (138K): [in a new window]   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.

View larger version (157K): [in a new window]   Figure 4b.  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.

View larger version (146K): [in a new window]   Figure 4c.  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.

View larger version (162K): [in a new window]   Figure 5.  Stent migration. Abdominal radiograph (right anterior oblique projection) shows distal migration of a Wallstent (arrow). Two additional stents (arrowheads) were placed in a malignant obstruction of the duodenum. The migrated stent remained in that position for 1 year of follow-up.

View larger version (128K): [in a new window]   Figure 6.  Recurrent gastric outlet obstruction due to tumor ingrowth. Anteroposterior radiograph from an upper gastrointestinal study shows a stricture inside a duodenal stent (arrow).

View larger version (150K): [in a new window]   Figure 7a.  Covered stent placement in a patient with unresectable adenocarcinoma of the duodenum. (a) Oblique radiograph from an upper gastrointestinal study shows a stricture of the first portion of the duodenum (arrow). (b) On an anteroposterior radiograph obtained during placement of a covered stent, the distal end of the stent is partially deployed (arrow). Metallic markers denote the location of the stricture. (c) Anteroposterior radiograph shows a fully expanded covered duodenal stent (arrow). (d) Oblique radiograph from an upper gastrointestinal study shows the stent in the duodenum (arrows) with a patent lumen.

View larger version (150K): [in a new window]   Figure 7b.  Covered stent placement in a patient with unresectable adenocarcinoma of the duodenum. (a) Oblique radiograph from an upper gastrointestinal study shows a stricture of the first portion of the duodenum (arrow). (b) On an anteroposterior radiograph obtained during placement of a covered stent, the distal end of the stent is partially deployed (arrow). Metallic markers denote the location of the stricture. (c) Anteroposterior radiograph shows a fully expanded covered duodenal stent (arrow). (d) Oblique radiograph from an upper gastrointestinal study shows the stent in the duodenum (arrows) with a patent lumen.

View larger version (133K): [in a new window]   Figure 7c.  Covered stent placement in a patient with unresectable adenocarcinoma of the duodenum. (a) Oblique radiograph from an upper gastrointestinal study shows a stricture of the first portion of the duodenum (arrow). (b) On an anteroposterior radiograph obtained during placement of a covered stent, the distal end of the stent is partially deployed (arrow). Metallic markers denote the location of the stricture. (c) Anteroposterior radiograph shows a fully expanded covered duodenal stent (arrow). (d) Oblique radiograph from an upper gastrointestinal study shows the stent in the duodenum (arrows) with a patent lumen.

View larger version (146K): [in a new window]   Figure 7d.  Covered stent placement in a patient with unresectable adenocarcinoma of the duodenum. (a) Oblique radiograph from an upper gastrointestinal study shows a stricture of the first portion of the duodenum (arrow). (b) On an anteroposterior radiograph obtained during placement of a covered stent, the distal end of the stent is partially deployed (arrow). Metallic markers denote the location of the stricture. (c) Anteroposterior radiograph shows a fully expanded covered duodenal stent (arrow). (d) Oblique radiograph from an upper gastrointestinal study shows the stent in the duodenum (arrows) with a patent lumen.

View larger version (130K): [in a new window]   Figure 8.  Stent placement for combined duodenal and biliary obstructions. Anteroposterior abdominal radiograph shows percutaneously placed biliary stents (arrowheads) and a duodenal stent (arrow).