Percutaneous transhepatic access to allow per-oral enteric stent insertion for malignant duodenal obstruction following failed endoscopic attempt

The treatment options for malignant gastric outlet obstruction include antegrade stent placement or surgical bypass, the latter being associated with a higher level of morbidity and therefore often reserved for cases in which stenting is not technically possible. Antegrade stent placement can be endoscopic, fluoroscopic or a combination. We report a case in which standard antegrade attempts at stenting failed, but where it was possible to use a retrograde approach via the biliary tree to facilitate technically and clinically successful stent placement.