# Novel Use of a Soehendra Biliary Dilatation Catheter and Controlled Radial Expansion Balloon To Gain Access Through an Existing Duodenal Stent via Complex Endoscopic Retrograde Cholangiopancreatography: A Case Report

## TL;DR

A new technique using specific tools allows ERCP access through a duodenal stent in a patient with a malignant stricture.

## Contribution

A novel method using a Soehendra Biliary Dilatation Catheter and CRE balloon for ERCP access through a stent mesh is described.

## Key findings

- The technique successfully widened the stent mesh to allow ERCP access.
- This method is feasible for complex ERCP cases in palliated patients.
- The approach has not been previously documented in the literature.

## Abstract

We report the case of a malignant type II duodenal stricture treated with an uncovered duodenal stent, later requiring endoscopic retrograde cholangiopancreatography (ERCP) for biliary obstruction. The ampulla was covered with a stent mesh. The procedure was performed through the meshed duodenal stent to access the bile duct. In our case, we used a Soehendra Biliary Dilatation Catheter (Cook Medical®, Limerick, Ireland) and controlled radial expansion (CRE) to facilitate the passage of a fully covered self-expandable metal stent through the mesh. This technique has not been previously described in the literature. It demonstrates the feasibility of accessing malignant strictures in palliated patients by the use of a CRE balloon and a Soehendra Biliary Dilatation Catheter to widen the uncovered duodenal stent mesh in complex ERCP cases.