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Unanticipated buried endoscopic ultrasound-guided lumen-apposing metal stent for gastroenterostomy concerning for potential dehiscence
A 55-year old man presented with a gastric outlet obstruction from metastatic duodenal cancer. Given his poor performance status from malnutrition, we decided to perform an endoscopic ultrasound (EUS)-guided gastroenterostomy with a lumen-apposing metal stent (LAMS). The procedure was performed successfully utilizing nasojejunal water irrigation and free-hand deployment of a 15-mm cautery-enhanced LAMS through the antrum ([Fig. 1]). The patient was discharged the following day tolerating oral intake. He developed a biliary obstruction 1 month later and EUS-guided choledochoduodenostomy was performed. During this endoscopy, the previously placed LAMS was noted to be completely buried within the gastric wall with purulent material oozing from the embedded margin ([Video 1], [Fig. 2], [Fig. 3]). Given the concern for separation between lumens, a through-the-scope 18 mm × 6 cm long, fully covered metal stent was placed through the LAMS and oriented along the jejunal lumen. Three months later, the patient remains asymptomatic, maintaining weight and undergoing chemotherapy.
Video 1 A previously placed lumen-apposing metal stent (LAMS) was buried within the gastric wall. Given the concern for separation between lumens, a fully covered metal stent was placed through the LAMS.
EUS-guided gastroenterostomy with LAMS is a novel and disruptive alternative procedure that may offer long-lasting patency with less stent failure . Retrospective series report stent dwell and patency ranging from 126 days for malignant disease to 319 days in benign scenarios . Premature buried LAMS as early as 5 weeks has also been described when placed for drainage of pancreatic fluid collections .
We report a case of premature buried LAMS with a potential for lumen separation, supporting the need for prospective data for this technique.
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
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11 November 2020 (online)
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- 2 Kerdsirichairat T, Irani S, Yang J. et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 07: E144-E150
- 3 Bang JY, Hasan M, Navaneethan U. et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66: 2054-2056