Endoscopic-guided Transgastric Laparoscopic Retrieval of a Duodenal Stent

Maureen M Tedesco, MD, Tonya Kaltenbach, MD MS, Roy Soetikno, MD, Dan Eisenberg, MD MS. Stanford University Medical Center and Palo Alto VA HCS


Introduction:  Endoscopic placement of expandable Nitinol stents have been used in the upper and lower gastrointestinal tract to palliate areas of malignant stricture or obstruction. They are designed to allow for endoscopic removal if necessary. Stent retrieval, however, can be difficult using endoscopic techniques, and may require an operation for removal. Here we describe a transgastric laparoscopic technique used to retrieve a duodenal stent, under endoscopic guidance.

Case: A 61 year-old man presented with duodenal obstruction which was thought to be due to an inoperable malignant neoplasm of the head of the pancreas. A Nitinol, uncovered stent was placed in the duodenum endoscopically, after which the mass was determined to be benign. Upper endoscopic attempts to retrieve the stent were unsuccessful, and the deformed stent was lodged at the pylorus, leading to a gastric outlet obstruction. He was brought to the operating room for an endoscopic-guided transgastric laparoscopic retrieval of the stent.

Conclusion: Transgastric laparoscopy with endoscopic guidance is an effective approach to intralumenal stomach surgery. Simultaneous laparoscopic and endoscopic views allow for multiple concurrent views and a high degree of safety.

Session Number: SS25 – Videos: NOTES / Flexible Endoscopy
Program Number: V068

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