Endoscopic Management of Delayed Presentation of Iatrogenic Type 1 Duodenal Perforation Using Off-Label Esophageal Fully Covered Self-Expandable Metal Stent.

We present the case of a 75-year-old woman with pancreatic cancer who presented with a type 1 duodenal perforation (large lateral wall perforation) following endoscopic retrograde cholangiopancreatography for palliative biliary stent replacement. Owing to prohibitive operative risk and based on multispecialty input, surgical intervention was deferred in favor of a salvage, off-label, endoscopic deployment of an esophageal fully covered self-expandable metal stent to traverse the area of perforation and facilitate healing by secondary intention, which was ultimately successful. This case demonstrates the feasibility of a nonoperative approach in the management of duodenal perforations in high-risk surgical candidates.