Through-the-scope fully covered self-expandable metal stent with biflanged ends for ampullary access in severe duodenal obstruction.

Background and Aims: Indeterminate gastric outlet obstruction can be managed with placement of temporary stents; however, currently available stents are not designed for duodenal placement, and downstream migration is a significant concern. Methods: This Original Article and accompanying video demonstrate placement of a through-the-scope fully covered self-expandable metal stent (FCSEMS) with biflanged ends across the duodenal stenosis. Results: In the case example of a patient with severe duodenal stenosis, despite utilization of a lumen-apposing metal stent, various duodenoscopes, and patient repositioning, the ampulla could not be reached. Subsequently, the FCSEMS with biflanged ends (midbody diameter: 20 mm; flare diameter: 28 mm) was placed across the duodenal stenosis, and ERCP could be successfully performed through the stent. Conclusions: This case highlights the successful placement of an FCSEMS with biflanged ends in a patient with indeterminate gastric outlet obstruction for eventual ampullary access. The wide caliber of the stent allowed duodenoscope maneuverability and sphincterotome bowing to facilitate ERCP. The biflanged ends on the FCSEMS may potentially provide antimigratory properties, which is a concern for currently available stents for the management of duodenal obstruction.