Pancreatic Cancer | November 2021-EUS-guided stent placement for afferent limb and gastrojejunal obstruction in a patient with pancreatic cancer

Pdf Summary

This video case report discusses the use of EUS-guided stent placement for afferent limb and gastrojejunal obstruction in a patient with pancreatic cancer. Gastric outlet obstruction is a common complication of pancreatic cancer, and afferent loop syndrome can occur in patients with recurrence, leading to distal obstruction and recurrent cholangitis. EUS-guided gastroenterostomy is a less invasive alternative to surgical gastroenterostomy or enteral stent placement. <br /><br />The video case describes the procedure performed on a 46-year-old woman with pancreatic adenocarcinoma who presented with symptoms of obstruction. A fully covered self-expandable metal stent in the stomach was removed, and severe strictures in the gastrojejunostomy were identified. The decision was made to bypass the strictures on both limbs. A lumen-apposing metal stent (LAMS) was deployed in the afferent limb and the efferent limb under endoscopic, fluoroscopic, and endosonographic guidance. Double-pigtail plastic stents were deployed across both LAMS for anchoring. The procedure was successful, and the patient reported improved symptoms on follow-up.<br /><br />The video case concludes that endoscopic gastrojejunostomy is a novel therapeutic technique for palliating malignant gastric outlet obstruction and afferent limb syndrome. It is a less invasive approach with comparable outcomes to the surgical approach. The use of LAMS allows for the creation of a direct anastomosis between obstructed areas, providing effective relief for patients with obstructive symptoms.<br /><br />Overall, this video case highlights the potential benefits and success of EUS-guided stent placement in managing gastric outlet obstruction and afferent limb syndrome in patients with pancreatic cancer.

Asset Subtitle

Link to audio file:
https://www.videogie.org/cms/10.1016/j.vgie.2021.02.008/attachment/ec7b7925-1162-482a-b907-b8a988fad3f0/mmc1.mp4

Meta Tag

Disease Gastric Outlet Obstruction

Instrument & Accessory Used Lumen Apposing Metal Stents (LAMS)

Procedure EUS-Guided Gastroenteroscopy

Keywords

EUS-guided stent placement

afferent limb obstruction

gastrojejunal obstruction

pancreatic cancer

gastric outlet obstruction