Endoscopic Biliary Drainage Using Guidewire Cannulation in a Case with Severe Duodenal Stenosis Caused by Duodenal Undifferentiated Carcinoma

Abstract

We present a case of duodenal carcinoma, 12 cm in size, with severe stenosis at the second portion of the duodenum. When the patient developed obstructive jaundice, it was impossible to perform endoscopic biliary drainage by standard cannulation due to the stenosis, but was succeeded by wire-guided cannulation using papillotome. Histology of the tumor showed undifferentiated carcinoma without differentiation to any specific cell type. Systemic chemotherapy was started with 5-FU, leucovorin and oxaliplatin. Biliary stent worked well until the patient succumbed three months after. Herein we demonstrate the new advantage of wire-guided cannulation in case of duodenal stenosis.

Fig. 1

Abdominal CT showing a bulky tumor located at the second portion of the duodenum, 12 cm in largest diameter.

Fig. 2

a Endoscopic view of the duodenum showing a large tumor with ulceration and necrosis, and with duodenal stenosis at the second portion. b Histology of forceps biopsy from the tumor demonstrates undifferentiated carcinoma with abundant inflammatory cell infiltration (×100, hematoxylin and eosin).

Fig. 3

Guidewire cannulation using papillotome (a), following deep cannulation to the bile duct (b) and biliary stent insertion (c).