# Endoscopic Duodenal Stenting for Iatrogenic Stapfer Type I Duodenal Perforation: An Alternative to Surgical Repair

## TL;DR

This paper presents a case where a duodenal perforation was successfully treated with a stent instead of surgery, offering a less invasive option for high-risk patients.

## Contribution

The first documented case of using a fully covered self-expandable metallic stent for a Stapfer Type I duodenal perforation.

## Key findings

- A fully covered self-expandable metallic stent was successfully used to treat a duodenal perforation.
- The patient showed rapid clinical and radiologic improvement and full recovery after two months.
- Stent removal was successful, confirming the viability of this approach as an alternative to surgery.

## Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential therapeutic tool but carries risks of serious complications, including luminal perforation. Stapfer Type I perforations, involving lateral or medial duodenal wall tears, are traditionally managed surgically with high associated morbidity/mortality. Here, we report the first documented case to our knowledge of an iatrogenic post-dilation Stapfer Type I duodenal perforation successfully managed with placement of a fully covered self-expandable metallic stent (Fc-SEMS). An 87-year-old female with a history of chronic obstructive pulmonary disease, coronary artery disease, hypertension, and hypothyroidism presented with cholestatic transaminitis and suspected biliary obstruction. Endoscopic evaluation during ERCP revealed a pre-ampullary peptic duodenal stricture not traversable with the duodenoscope. Endoscopic dilation with a CRE balloon led to a duodenal perforation and a through-the-scope duodenal Fc-SEMS was deployed bridging the perforation. The patient demonstrated rapid clinical and radiologic improvement, with full recovery and successful stent removal in two months. This case highlights Fc-SEMS as a viable, less invasive alternative to surgery for high-risk patients who have sustained a duodenal perforation.