St. Elizabeth's Medical Center, Tufts University School of Medicine Brighton, MA, United States
Mohammad Abudalou, MBBS1, Marcel R. Robles, MD2, Sandeep Krishnan, MD, PhD1 1St. Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, MA; 2Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, MA
Introduction: The management of gastrointestinal strictures that is refractory to endoscopic treatment has been challenging. Lumen apposing metal stents (LAMS) is used for the treatment of pancreatic fluid collection. However, it has been used off-label for different gastrointestinal pathologies. We report a case of 82 years-old male who presented with gastric outlet obstruction secondary to gastrojejunal stricture post pancreatoduodenectomy that was successfully managed with LAMS.
Case Description/Methods: 82 years old male with history of pancreatoduodenectomy performed for 3.7 x 3.1cm pancreatic head branch duct intraductal papillary mucinous neoplasm. Two months after surgery, he developed decreased per oral intake secondary to intermittent vomiting and weight loss. An esophagogastroduodenoscopy (EGD) showed a gastrojejunal anastomosis stricture causing near complete obstruction. Subsequently, he underwent two endoscopic balloon dilatation. His symptoms improved, but he continued to have difficulties with solid food. He underwent another EGD showing moderate stenosis at the gastrojejunostomy site and a lumen apposing metal stent was placed. Afterwards, he was able to fully tolerate food. The stent was removed four months after placement and since then, he continued to do well and able to tolerate solid and liquids without difficulty.
Discussion: LAMS have been shown to effective in managing peripancreatic fluid collections such as pseudocysts and walled off necrosis. LAMS is preferred over plastic stents because of better drainage and the easiness of access allowing to perform different procedures such as necrosectomy. Our case highlights another off label use in a gastrojejunal anastomotic stricture which is usually managed with endoscopic interventions such as balloon dilatation, steroid injection or by incisional therapy, which in some cases, can be refractory to these interventions. In our patient, balloon dilatation partially managed the gastric outlet obstruction as he continued to have difficulty with solid food. Placement of LAMS achieved a complete resolution of his symptoms and he continued to do well after recovering of the stent. We propose that the use of LAMS should be further investigated and it could possibly become an upfront intervention for gastric outlet obstruction caused by post-surgical strictures.
Figure: Figure 1: lumen apposing metal stent placed at the site of gastrojejunal stricture.
Disclosures:
Mohammad Abudalou indicated no relevant financial relationships.
Marcel Robles indicated no relevant financial relationships.
Sandeep Krishnan indicated no relevant financial relationships.
Mohammad Abudalou, MBBS1, Marcel R. Robles, MD2, Sandeep Krishnan, MD, PhD1. P1734 - Lumen Apposing Metals Stents in the Management of Post-surgical Strictures, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
