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CC BY 4.0 · Endoscopy 2025; 57(S 01): E907-E908
DOI: 10.1055/a-2648-7338
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An anatomically designed duodenal stent with physiological drainage: effective endoscopic rescue in persistent perforation

Authors

  • Shao-wei Li‡

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
    2   Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, China
    3   Institute of Digestive Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China

  • Xin-yu Fu‡

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
    4   Dalian Medical University, Dalian, China (Ringgold ID: RIN36674)

  • Jinbang Peng

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China

  • Saiqin He

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China

  • Binbin Gu

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China

  • Xinli Mao

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
    2   Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, China
    3   Institute of Digestive Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China

  • Li-ping Ye

    1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
    2   Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, China
    3   Institute of Digestive Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China

Supported by: “Pioneer” and “Leading Goose” R&D Program of Zhejiang 2025C02139
Supported by: Program of Taizhou Science and Technology Grant 23ywa33
Supported by: Scientific Research Foundation of Taizhou Enze Medical Center Grant 24EZCG02
Supported by: Major Research Program of Taizhou Enze Medical Center Grant 19EZZDA2
Supported by: Open Project Program of Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province 21SZDSYS01
Supported by: Doctoral Fund of Taizhou Enze Medical Center Grant 2018BSKYQDJJ14
Supported by: Medical Science and Technology Project of Zhejiang Province 2024KY1788, 2022PY101
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A 70-year-old woman with a refractory duodenal ulcer developed a 1.5-cm perforation at the duodenal bulb following two failed attempts at endoscopic hemostasis ([Fig. 1]). Placement of an over-the-scope clip for closure was unsuccessful, and resulted in sepsis.

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Fig. 1 Endoscopic views showing: a the original duodenal perforation; b a failed closure attempt using over-the-scope clips.

A nitinol duodenal covered stent (22 mm in diameter, 10 cm in length) was deployed endoscopically ([Fig. 2], [Video 1]). This stent integrates three key innovations: (i) a tripartite anchoring system – an umbrella-shaped gastric component for antral apposition, a cylindrical pyloric segment for radial fixation, and a bulbous duodenal anchor for coaptation; (ii) a papilla-aligned fenestration within the membranous mid-section to preserve physiological pancreatobiliary drainage; and (iii) optimized radial force distribution across segmented zones to minimize migration. Follow-up at 15 days confirmed closure of the complete perforation, and the stent was safely retrieved.

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Fig. 2 Images of treatment with a duodenal stent showing: a the fistula prior to insertion of the stent; b stent deployment; c the anchoring mechanism; d stent retrieval after the perforation had healed; e the anatomical design of the stent; f the healed perforation site.
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An anatomically designed duodenal stent that can both obliterate the fistula and provide physiological drainage is used to close a perforation of a refractory duodenal ulcer in an elderly frail woman.Video 1

Duodenal perforations are challenging owing to anatomical fragility and the enzyme-rich secretions [1] [2]. Conventional stents risk migration and obstructing drainage, thereby exacerbating leaks [3]. An anatomically designed duodenal stent uniquely addresses these limitations: its anchoring system ensures stable positioning without tissue injury, while the fenestration aligns precisely with the papilla, allowing continuous biliary/pancreatic flow into the bowel lumen. This design prevents reflux-related complications and promotes fistula healing by isolating the defect from digestive enzymes. The case underscores the stent’s dual role as a mechanical sealant and physiological conduit, which may be particularly critical in elderly patients with impaired healing.

Endoscopy_UCTN_Code_TTT_1AO_2AZ

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Li-ping Ye, MD
Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University
150 Ximen Street
Linhai 317000, Zhejiang Province
China   

Publication History

Article published online:
20 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Endoscopic views showing: a the original duodenal perforation; b a failed closure attempt using over-the-scope clips.
Zoom
Fig. 2 Images of treatment with a duodenal stent showing: a the fistula prior to insertion of the stent; b stent deployment; c the anchoring mechanism; d stent retrieval after the perforation had healed; e the anatomical design of the stent; f the healed perforation site.