TREATMENT OF AORTODUODENAL SYNDROME (ADS) WITH EUS-GUIDED GASTROENTEROSTOMY (EUS-GE)

ADS is a very rare condition characterized by nausea, vomiting, abdominal pain, malnourishment, and weight loss. ADS is caused by upper gastrointestinal obstruction due to an abdominal aorta aneurysm (AAA). Most patients are treated with open surgery with AAA repair and gastro-enteral anastomosis. EUS-GJ with lumen apposing metallic stents (LAMS) is a technique to create a fistula between the stomach and the jejunum, to relieve symptoms in case of gastric outlet obstruction. We describe the first case of ADS managed endoscopically with EUS-GE.

Methods:

The patient is an 80-year-old male with severely generalized arteriosclerosis, COPD GOLD III with home oxygen treatment and AAA measuring 56 mm in diameter. Twelve months prior to consultation, he had been admitted several times with respiratory failure and aspiration pneumonia. His complaints were constant satiety, nausea, abdominal pain, vomiting, and weight loss. CT scan revealed severe gastric and duodenal retention and enlargement of the horizontal duodenum, where an infrarenal AAA caused compression of the bowel.

The patient was deemed unfit for surgery. A naso-enteral tube was initially placed for decompression of the stomach after we could observe clinical improvement. After consent, we performed EUS-GE with a 15 mm LAMS (Hot Axios, Boston Scientific, USA) with freehand technique.

Results:

The procedure lasted 30 min in general anesthesia. The patient could start on liquid fluid after 24 hours. His condition gradually improved, and he was discharged within three days. During nine months follow-up, the patient experienced neither aspiration pneumonia nor relapse of respiration failure. CT scan of the abdomen showed normalization of the gastric and duodenal distention. This is the first known case of ADS which has been treated endoscopically.

Conclusions:

EUS-GE may be an option to treat patients with ADS who are unfit for surgery.