Platzierung von drei Duodenalstents: Problem der Platzierung beim fortgeschrittenen Tumorprogress

Pancreatic adenocarcinoma, while only the 10 th most common carcinoma, is the fourth leading cause of cancer-related mortality. The three most important symptoms that should be treated in advanced pancreas cancer are obstructive jaundice, duodenal obstruction, and pain. Self-expandable metal stents are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Peroral intubation of a stent is usually difficult in patients with unresect-able malignant gastric outlet obstruction, because the delivery systems currently available are not long enough and cannot easily pas the angulated gastroduodenal structure. Through-the-scope stents facilitate the placement. In our patient, bile duct stent placement and threefold duodenal stent placement seems to be technically feasible and effective for palliative treatment of recurrent obstruction. We report a technique in a difficult placement of the second and third duodenal stent.