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

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.