Commentary

Endoscopic ultrasound-guided gastrojejunal anastomosis with lumen-apposing metal stents (LAMSs) has recently emerged as an alternative to surgical bypass or endoscopic enteral stenting in patients with gastric outlet obstruction (GOO). The rates of technical (80 % – 100 %) and clinical success (73 % – 100 %) are high, rates of adverse events (3.5 % – 25 %) are acceptable, and the majority of patients (77 % – 100 %) do not require re-intervention for symptom recurrence. The reported experience is limited to retrospective cohort studies, and predominantly to patients with malignant GOO; however, LAMS gastrojejunostomy has also been used to manage obstruction related to peptic ulcer disease, anastomotic strictures, chronic and acute pancreatitis, or rare causes such as superior mesenteric artery syndrome as presented in this video case. Preliminary data suggest that surgery can be avoided in more than 80 % of benign cases; however, the long-term effects of LAMS gastrojejunostomy in the setting of benign GOO, and the optimal timing and safety of stent removal, remain to be determined.

Publication History

Article published online:
27 January 2021