Novel Use of a Soehendra Biliary Dilatation Catheter and Controlled Radial Expansion Balloon To Gain Access Through an Existing Duodenal Stent via Complex Endoscopic Retrograde Cholangiopancreatography - A Case Report

Sep 28, 2026

Uploaded by James

A case describes a malignant type II duodenal stricture initially managed with an uncovered duodenal stent, later complicated by biliary obstruction requiring endoscopic retrograde cholangiopancreatography (ERCP). Access to the bile duct was achieved through the stent mesh after ampullary coverage. A Soehendra Biliary Dilatation Catheter and controlled radial expansion (CRE) balloon enabled passage of a fully covered self-expandable metal stent through the mesh. The approach has not been previously reported and supports feasibility for complex ERCP palliative settings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Malignant biliary obstruction and standard management

ERCP and duodenal stenting sequence

Case Presentation

Initial diagnosis and first ERCP

Development of gastric outlet obstruction and duodenal stenting

Follow-up and need for complex ERCP access

Review began 11/08/2025 Review ended 11/30/2025 Published 12/03/2025 © Copyright 2025 Abbasi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98358 Open Access Case Report Novel Use of a Soehendra Biliary Dilatation Catheter and Controlled Radial Expansion Balloon To Gain Access Through an Existing Duodenal Stent via Complex Endoscopic Retrograde Cholangiopancreatography: A Case Report Rida Abbasi 1, Mohammed Korani 2, Javaid Iqbal 1 , Venkata Lekharaju 2, Daniyal Baig 2, Sajjad Mahmood 2 1. Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR 2. Gastroenterology and Hepatology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR Corresponding author: Rida Abbasi, [rida.abbasi@mft.nhs.uk](rida.abbasi@mft.nhs.uk) Abstract We report the case of a malignant type II duodenal stricture treated with an uncovered duodenal stent, later requiring endoscopic retrograde cholangiopancreatography (ERCP) for biliary obstruction. The ampulla was covered with a stent mesh. The procedure was performed through the meshed duodenal stent to access the bile duct. In our case, we used a Soehendra Biliary Dilatation Catheter (Cook Medical®, Limerick, Ireland) and controlled radial expansion (CRE) to facilitate the passage of a fully covered self-expandable metal stent through the mesh. This technique has not been previously described in the literature. It demonstrates the feasibility of accessing malignant strictures in palliated patients by the use of a CRE balloon and a Soehendra Biliary Dilatation Catheter to widen the uncovered duodenal stent mesh in complex ERCP cases. Categories: Gastroenterology Keywords: controlled radial expansion (cre) balloon dilation, duodenal stricture, ercp, malignant biliary obstruction, pancreatic cancer, pancreatobiliary, soehendra biliary dilatation catheter Introduction Malignant biliary obstruction (MBO) causing jaundice can be challenging to manage [1] . Commonly caused by pancreatic adenocarcinoma or cholangiocarcinoma, biliary drainage is recommended to decompress the biliary tree for symptomatic improvement, facilitating the progression of treatment to the next stage of management [2] . Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion is well established and the preferred option, with success rates of around 90%[3,4] . Additionally, approximately 15- 20% of patients with pancreatic cancers develop gastric outlet obstruction [5,6], often presenting later in the disease course. Duodenal stenting is a safe and effective procedure that improves symptoms of gastric outlet obstruction, enabling better nutrition, early discharge from the hospital, and possibly improved survival by allowing for chemotherapy [7,8] . The majority of patients present with jaundice first and then progress at a later stage to develop duodenal obstruction. Therefore, ERCP would have been performed in these patients, establishing adequate biliary drainage, making duodenal stent insertion the next step. Here, we report a case where the patient underwent duodenal stent insertion for a malignant duodenal stricture and later developed jaundice due to MBO requiring biliary drainage. ERCP through previously placed duodenal stents has been described in the literature. It is a challenging procedure, particularly in type II obstruction [9, 10] . Such complex procedures are best performed in centers performing high volumes of ERCP [11, 12]. Usage of either rat-tooth forceps or argon plasma coagulation for the removal or melting of wires ofthe stent’s mesh has been reported. In our case, we used a controlled radial expansion (CRE) balloon and Soehendra Biliary Dilatation Catheter (Cook Medi

FAQs

What clinical problem prompted the ERCP in this case?

After initial management of a malignant duodenal stricture with an uncovered duodenal stent, the patient later developed biliary obstruction, requiring ERCP for biliary drainage.

How was biliary access achieved through the existing duodenal stent?

The procedure used ERCP access through the meshed duodenal stent by dilating the mesh with a Soehendra Biliary Dilatation Catheter and a controlled radial expansion (CRE) balloon to allow passage of a fully covered metal stent.

Why is this technique considered novel?

The case report states that using a CRE balloon and a Soehendra Biliary Dilatation Catheter to widen an uncovered duodenal stent mesh for complex ERCP access through the mesh had not been previously described in the literature.

Sep 28, 2026

Uploaded by James