Endoscopic fenestration of duodenal stents using argon plasma to facilitate ERCP

Background: The presence of a duodenal stent may hinder attempts at ERCP for treatment of malignant biliary obstruction. Objective: We describe 2 patients in whom endoscopic fenestration of indwelling duodenal stents with an argon plasma coagulator facilitated successful ERCP. Design: Single-center retrospective case series. Setting: Tertiary-referral center. Patients: Both patients had unresectable biliary malignancy with both duodenal and biliary obstruction. Intervention and Results: Windows were cut into indwelling duodenal stents with argon plasma, which exposed the underlying papilla and allowed successful ERCP and stent placement. Limitations: Retrospective study and the small sample size. Conclusions: Fenestration of duodenal stents using argon plasma is a simple technique that can facilitate ERCP.