RECURRENT METASTATIC UROTHELIAL CANCER PRESENTING WITH DUODENAL OBSTRUCTION MANAGED SUCCESSFULLY WITH ENDOSCOPIC STENTING AND STENT DILATATION

Aims Urothelial cancers can rarely metastasize to the duodenum and can present with duodenal obstruction as the main presentation. Duodenal obstruction due to urothelial cancer can be managed either by surgery or luminal stenting. we present a case where the duodenal obstruction was managed successfully by endoscopic luminal stenting.

Methods 60 year patient with a history of urothelial cancer in remission. Patient has received the BCG vaccine as part of therapy and was recently diagnosed to have BCG vaccine-related genitourinary tuberculosis. He presented with persistent vomiting for more than 2 weeks. After initial workup didn’t reveal obviously caused gastroscopy was performed which showed features of gastric outlet obstruction with duodenal stenosis at third part. Biopsies proved recurrence of urothelial cancer with metastasis to the duodenum.

Results The patient underwent luminal stenting under fluoroscopic guidance with a partially covered stent 12 cm by 20 mm in length and diameter respectively. No immediate complications were noted, however, the patient did not have significant symptomatic improvement. Repeat gastroscopy showed narrowing across the stent due to compression of the tumor. Balloon CRE dilatation was done 6, 7, and up to 8mm. The patient had subsequent significant symptomatic improvement, follow-up gastroscopy showed patent stent, and no further dilatation was required. The patient started palliative systemic chemotherapy. At four months follow up he was having a well-functioning stent.

Fig. 1

Conclusions Duodenal obstruction from extraintestinal tumors such as urothelial cancer can be managed successfully by endoscopic stenting. The stent may require balloon dilatation if not fully expanded due to tumor compression.

Publication History

Article published online:
14 April 2022