Duodenal stenosis is commonly caused by peptic ulcer disease, Crohn’s disease, neoplasms, extrinsic compression, or, rarely, infections. Standard management of benign stenosis includes endoscopic balloon dilation; however, success may be limited in refractory or anatomically complex strictures. Lumen-apposing metal stents (LAMS), such as the AXIOS stent, have emerged as a novel therapeutic option in these challenging cases.

We report the case of a 20-year-old male with a history of para-aortic paraganglioma requiring extensive resection and subsequent radiotherapy, who later developed recurrent disease and retroperitoneal fibrosis. He presented with elevated liver enzymes and was found on MRCP to have intrahepatic biliary dilation and intrabiliary cast formation. Attempts at ERCP were unsuccessful due to a severe intrinsic duodenal bulb stenosis that limited passage of a standard endoscope despite multiple sessions of stepwise balloon dilation up to 15 mm. Given persistent failure to traverse the stricture, a multidisciplinary decision was made to deploy a 20 mm × 10 mm AXIOS (Boston Scientific) LAMS across the stenosis under combined endoscopic and fluoroscopic guidance. The stent remained in place for 10 days without adverse events, allowing successful duodenoscope passage and ERCP, with partial extraction of biliary stones and sludge and subsequent cholangioscopic evaluation.

This case highlights the effective use of LAMS as a bridge to ERCP in benign, refractory duodenal stenosis. The stent dwell time was 10 days with no stent migration or adverse event reported with no recurrence of biliary stenosis up to 3 months follow up.

Current literature demonstrates high technical and clinical success rates for LAMS in benign gastrointestinal strictures, with acceptable adverse event rates. Our case adds to growing evidence supporting LAMS as a safe and effective option when standard dilation fails.