Migrated duodenal stent 8 months after placement for invasive pancreatic adenocarcinoma.

Competing Interests: Disclosure The following author disclosed financial relationships: V. Kushnir: Consultant for Boston Scientific. All other authors disclosed no financial relationships. Commentary The treatment of malignant duodenal obstruction is an area of ongoing development, and one should thoughtfully consider whether a surgical gastrojejunostomy, EUS-guided gastrojejunostomy, or self-expanding metal duodenal stent is best for an individual patient. Here, we see the unwelcomed development of delayed distal migration after placement of a duodenal stent. As the authors point out, this is unusual because of the relatively rapid engraftment of these stents to the surrounding mucosa and suggests that perhaps the original stent may have been too distal during placement. Regardless, the authors quickly used a clever solution using the gastrojejunostomy access to endoscopically retrieve the stent before it could cause further small-bowel obstruction or perforation. This case illustrates an important aspect of interventional endoscopy: The interventional endoscopy team should not only be able to perform a procedure, but should also have a plan and the required skills for controlling subsequent adverse events. Matthew T. Moyer, MD, MS, Division of GI Hepatology, Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points