Endoscopic fenestration of duodenal stents using argon plasma to facilitate ERCP

BackgroundThe presence of a duodenal stent may hinder attempts at ERCP for treatment of malignant biliary obstruction.ObjectiveWe describe 2 patients in whom endoscopic fenestration of indwelling duodenal stents with an argon plasma coagulator facilitated successful ERCP.DesignSingle-center retrospective case series.SettingTertiary-referral center.PatientsBoth patients had unresectable biliary malignancy with both duodenal and biliary obstruction.Intervention and ResultsWindows were cut into indwelling duodenal stents with argon plasma, which exposed the underlying papilla and allowed successful ERCP and stent placement.LimitationsRetrospective study and the small sample size.ConclusionsFenestration of duodenal stents using argon plasma is a simple technique that can facilitate ERCP.