• A 55 yrs old female was referred to us for the favor of ERC and metal biliary stenting for an advanced metastatic pancreatic cancer invading the duodenum leading to cholestatic symptoms
  • Duodenoscopy revealed large ulcerating mass in the second part of duodenum extending up to D3
  • The ampullary anatomy was completely distorted and despite several attempts selective cannulation of CBD failed
  • EUS was then performed which revealed a massively dilated CBD with a block at the lower end on color doppler and EUS guided puncture of the CBD was done
  • A guidewire was placed and sequential dilatation of the CD was carried out
  • A 4 cms completely covered metal stent was then deployed on endoscopy with the guidance of fluoroscopy

Large ulcerating mass in the second part of duodenum extending up to D3

Attempts at selective cannulation of the CBD transpapillary failed

 

 

 

 

 

 

 

 

A massively dilated CBD with a block at the lower end on color doppler

EUS GUIDED puncture of the CBD

 

 

 

 

 

 

 

 

A guidewire was placed and sequential dilatation of the CD

Fully covered metal stent passed through the duodenal bulb

 

 

 

 

 

 

 

 

A 4 cms completely covered metal stent was then deployed and free flow of bile was seen

Fluoroscopy showed a 4 cms covered metal stent was deployed

 

 

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