Atlas of Gastroenterological Endoscopy
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Dislocation of a wall stent and stent in stent insertion for carcinoma of the pancreatic head
Malignant stenosis An inoperable carcinoma of the pancreatic head is causing a distal, filliforme stenosis of the biliary duct.
Wallstent still mounted Wallstent deployed
For palliation a wall stent is inserted. On the left picture the stent is still mounted to the catheter, on the right picture the stent is deployed and protrudes 2 cm into the duodenal lumen.
Dislocation during dilatation Implantation of a second stent
Although a balloon dilatation is performed prior to stent deployment the stent fails to open up the stenosis sufficiently. A second balloon dilatation from inside the metall stent is attempted. (the left picture shows the x- ray marks of the ballon in the stenosis). The dilatation of the metall grid causes a contraction of the stent, it thus is retracted into the biliary duct, producing a new distal stenosis. This is bridged by insertion of a plastic stent.
Stent in stent Stent in stent
Second look examination after 6 cycles of chemo- therapy. The plastic stent is still in place, biliary flow is unobstructed, there is no need to change the plastic stent.