An anatomically designed duodenal stent with physiological drainage: effective endoscopic rescue in persistent perforation

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.

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.

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.

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.

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• References

• 1 Saito K, Ishikawa Y, Kitahara M. et al. Novel rendezvous technique for covered metal stent placement using balloon-assisted endoscope in duodenal perforation. Endoscopy 2024; 56: E420-E421
• 2 Nakagawa Y, Nagai T, Soma W. et al. Endoscopic closure of a large ERCP-related lateral duodenal perforation by using endoloops and endoclips. Gastrointest Endosc 2010; 72: 216-217
• 3 Williams J, Joshi H, Schwartz M. et al. Endoscopic repair of duodenal perforations, a scoping review. Surg Endosc 2024; 38: 4839-4845