Fig. 5. (A) Percutaneous technique. Stomach distended with air (white asterisks) following insufflation via nasogastric tube (NGT; black arrow). Puncture site selection in posteroanterior plane (white arrow). (B) Stomach distended with air (white asterisks) following insufflation via NGT (black arrow). Puncture site confirmation in lateral plane (white arrow). (C) Two gastropexy sutures (white asterisks) in situ. Definitive puncture (black arrow) between sutures. (D) The 6 Fr vascular sheath (white arrows) placed between gastropexy sutures (white asterisks) and angled towards pylorus. Biliary Manipulation Catheter (William Cook Europe; black arrow) in duodenum. Stricture (black asterisks) delineated by contrast. (E) Biliary Manipulation Catheter (black arrow) manipulated across double duodenal stricture (black asterisks). (F) Amplatz Extra Stiff wire (William Cook Europe; white asterisks) deployed into the jejunum. The 6 Fr vascular sheath exchanged for 11 Fr vascular sheath (black arrows). Two EGIS double bare Nitinol stents (22 × 100 mm, S&G Biotech Inc.; white arrows) deployed across double duodenal stricture. (G) Following removal of the Amplatz Extra Stiff wire the insufflated air is aspirated via the 11 Fr vascular sheath (white asterisks) and the NGT (black asterisks) prior to gastropexy suture release.
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