ENDOSCOPIC ULTRASOUND (EUS)-GUIDED GASTROENTEROSTOMY WITH LUMEN APPOSING METAL STENT (LAMS) AS RESCUE THERAPHY FOR THE MANAGEMENT OF GASTRIC OUTLET OBSTRUCTION (GOO) AFTER DUODENAL STENT FAILURE

A 79-year-old woman with pancreatic neoplasia, previously treated with uncovered duodenal self-expandable metal (SEMS) for GOO, was admitted for jaundice and vomit. Endoscopy confirmed SEMS’s occlusion for neoplastic ingrowth.

EUS-guided choledoco-duodenostomy was performed using a 10x10mm electrocautery-enhanced LAMS (Hot-Axios, Boston Scientific). Novel SEMS was deployed through the previous duodenal stent with partial expansion of distal flange due to extended neoplastic infiltration. Considering the stent-in-stent tecnique failure, EUS-guided gastroenterostomy with a 20x10mm Hot-Axios was performed in a a “free-hand” fashion. A 0.035-inch guidewire was preventively passed through the LAMS delivery system and advanced into the jejunum to preserve the route.

Publication History

Article published online:
14 April 2022