PMC7145159_01
(A) High-grade afferent loop obstruction due to enlarging gastric mass with probable extragastric extension into the left upper quadrant and decompressed distal bowel. (B) Biliary and ductal dilatation, gallbladder dilatation, and pancreatic ductal dilatation.
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F1
Interval increase in biliary ductal dilatation, worst in the left hepatic lobe with concomitant gallbladder, and pancreatic duct distension were noted all consistent with downstream obstruction (Figure 1).
Gastric mass.
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F2
The mass caused near-total obstruction of both the pancreatobiliary and efferent limbs (Figure 2).
Double-guidewire technique.
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F3
A guidewire was passed into the afferent limb through the pediatric gastroscope after which a second guidewire was passed into the efferent limb (Figure 3).
(A) Afferent and efferent limb stents. (B) Afferent and efferent limb stents anchored together with a clip to prevent migration, demonstrating a "kissing-stents" technique.
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F4
A second uncovered metal stent was deployed across the gastric mass into the efferent limb under endoscopic and fluoroscopic guidance (Figure 4).
Fluoroscopy showing afferent and efferent limb stents anchored with a clip.
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F5
To prevent stent migration, a "kissing-stents" technique was used, and 2 clips were deployed to attach the gastric end of both metal stents (Figure 5).