LAUSR

Malignant gastroduodenal outlet obstruction (MGOO) is occasionally seen in patients with advanced pancreatic cancer. The endoscopic placement of selfexpandable metallic stents (SEMS) has proven to be an effective treatment for MGOO [1, 2]. However, the optimal treatment for MGOO that recurs after the placement of a duodenal SEMS remains unknown. Although a few reports have shown argon plasma coagulation (APC) to be effective for treating stenosis of metallic esophagogastric stents [3– 5], the application of APC to malfunction of a duodenal SEMS has not yet been reported. Hence, we are the first to report the case of a patient who underwent APC for recurrent MGOO after placement of two duodenal SEMS. An 82-year-old man with unresectable locally advanced pancreatic cancer underwent gemcitabine monotherapy after insertion of a duodenal SEMS for MGOO Video 1 Argon plasma coagulation performed as a treatment for restenosis after placement of two duodenal self-expandable metallic stents. ▶ Fig. 1 Computed tomographic finding in an 82-year-old man with recurrent gastric outlet obstruction after placement of two SEMS. The first stent (WallFlex duodenal stent, 22mm×6cm, uncovered type) was inserted into the third portion of the duodenum. The second duodenal stent (WallFlex duodenal stent, 22mm×9cm, covered type) was inserted as a stent-in-astent for obstruction of the first SEMS due to tumor ingrowth.