Through-the-scope self-expanding metal stent placement using newly developed short double-balloon endoscope for the effective management of malignant afferent-loop obstruction.

This is the first report of through-thescope (TTS) self-expanding metal stent (SEMS) placement, using a newly developed, short-type, double-balloon endoscope (S-DBE), for the palliation of malignant afferent-loop obstruction (ALO). The endoscope has a 3.2mm working channel and 152cm working length (EI-580BT; Fujifilm, Tokyo, Japan). The SEMS is a new Niti-S D pyloric/duodenal uncovered stent, with a diameter of 18mm and lengths of 6cm, 8cm, 10cm, or 12cm, which is deployed using a 9Fr×220cm delivery system (TaeWoong Medical Co., Ltd., Gimpo, South Korea). In the case presented here, the 6cm SEMSwas used. A 71-year-old woman, who had undergone pancreaticoduodenectomy for pancreatic cancer 5 years previously, was admitted for fever and acute abdominal pain. Computed tomography revealed dilation of the afferent loop, which was caused by bowel obstruction due to cancer recurrence (●" Fig.1). SEMS placement using the S-DBE was planned for palliation. S-DBE smoothly accessed the ALO lesion. Malignancy was confirmed from the endoscopic view (●" Fig.2), and the stenosis was recognized on the jejunograph (●" Fig.3). The SEMS was advanced through the S-DBE and deployed accurately at the target area under direct endoscopic view. TTS SEMS placement was successful, and immediate intestinal flow was confirmed visually (●" Video 1). Abdominal radiography 2 days after the procedure showed a palliated ALO (●" Fig.4). The patient started dietary intake 3 days after the proFig.1 Computed tomography scan revealed a dilated afferent loop.