Duodenal stricture in Crohn’s disease successfully managed with a fully covered metal stent-assisted with double pig-tail stents

A fully covered metal stent is a potentially feasible treatment option for refractory benign strictures, though stent migration limits its use [1] [2].

We present the case of a 21-year-old man diagnosed with Crohn’s disease (A2L3+4B2, CDAI: 59.14), who presented with a long-segment pyloroduodenal obstruction secondary to upper gastrointestinal Crohn’s disease. The patient presented with abdominal pain, vomiting, and significant weight loss, resulting in malnutrition. Endoscopy revealed pyloroduodenal stricture ([Fig. 1]). Upper gastrointestinal radiography showed a delayed passage of contrast medium through the pyloroduodenal region ([Fig. 2]). The patient received a 390 mg intravenous dose of ustekinumab. However, the obstruction persisted, and conservative anti-inflammatory treatment proved ineffective.

Fig. 1 Endoscopy revealed pyloroduodenal stricture.

Fig. 2 Upper gastrointestinal radiography showed a delayed passage of contrast medium through the pyloroduodenal region.

The patient declined surgery. The stricture is located in an anatomically curved and sharply angulated region. Endoscopic balloon dilation is suitable for short (<5 cm long) and straight strictures [3]; however, in this case, the stricture was curved, and its length >5 cm. Consequently, we opted to place a fully covered metal stent.

A fully covered stent was deployed at the site of stricture. Subsequently, two double pig-tail plastic stents were inserted in a perpendicular configuration to form an “X” effectively fixing the fully covered stent. The patient had membrane damage by local granulation tissue infiltration into the stent 2 weeks after stent placement. To prevent mucosal injury, the stent was removed using an inverted technique via the anal route successfully ([Video 1]). Postoperatively, the patient received symptomatic treatment, including acid suppression, gastric mucosal protection, and regular ustekinumab therapy for the underlying disease. Three months later, no evidence of recurrent strictures was observed.

Two double pig-tail stents in a perpendicular configuration, successfully fixed the fully covered stent.Video 1

This novel technique aims to reduce stent migration. Fully covered duodenal stent placement holds promise as a safe and effective treatment for refractory benign gastrointestinal strictures, offering the potential to delay or obviate the need for surgery.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Mohan BP, Chandan S, Garg R. et al. Lumen-apposing Metal Stents, Fully Covered Self-expanding Metal Stents, and Biodegradable Stents in the Management of Benign of GI Strictures A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2019; 53: 560-573
• 2 Hori Y, Hayashi K, Naitoh I. et al. Feasibility and safety of duodenal covered self-expandable metallic stent fixation: an experimental study. Surg Endosc 2019; 33: 4026-4031
• 3 El Ouali S, Click B, Holubar SD. et al. Natural history, diagnosis and treatment approach to fibrostenosing Crohn’s disease. United European Gastroenterol J 2020; 8: 263-270

Publication History

Article published online:
09 May 2025