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• W2161783863 abstract "To learn what we believe to be a novel approach to duodenal stenting using a transbiliary route that allows stents to be deployed over the major duodenal papilla. Endoscopic placement of duodenal stents can fail due to tight strictures or anatomical limitations. Deploying stents in duodenal segments proximal or distal to the duodenal papilla via a transhepatic approach has been previously described. However, in cases of papilla involvement, because the stent must cover the papilla, a transhepatic approach has historically been discarded. This method allows such an approach and has been successfully performed in patients with both native anatomy and with previous Roux-en-Y and Whipple's surgery. Percutaneous biliary access is often present or needed due to pre-existing biliary obstruction. Through the biliary access, a retroseeking catheter is advanced into the duodenum and used to cross the strictured segment. At the proximal portion of the wire, in the bowel, a loop away from the lesion is formed. In doing so, the wire passes from the CBD through the papilla, courses away from the lesion before looping back towards the papilla and crossing the lesion. The distal end of the wire that has crossed the stricture is stabilized by snaring it in the stomach from the mouth, in the case of native anatomies, or by having advanced it far distally, in post-surgical anatomies. The stent is then advanced over the wire via a percutaneous intrahepatic or a transoral route. Because the wire passes across the papilla, the stent can be deployed over the papilla. If there is concomitant biliary obstruction, a CBD stent can be deployed in a T-type fashion through the duodenal stent mesh. Several cases with differing anatomy are shown. This method has allowed our fluoroscopic guided trans-duodenal stent placements to be successful irrespective of tumor location or tightness of the stricture. Even in cases of awkwardly situated lesions, failures of endoscopic placement are no longer viewed as the last attempt. If needed, the approach also allows both duodenal and CBD stenting in a single sitting." @default.
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• W2161783863 date "2010-02-01" @default.
• W2161783863 modified "2023-09-26" @default.
• W2161783863 title "Abstract No. 228 EE: Duodenal stenting over the major duodenal papilla using a transhepatic approach" @default.
• W2161783863 doi "https://doi.org/10.1016/j.jvir.2009.12.013" @default.
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