Hybrid gastroenterostomy using a lumen-apposing metal stent: a case report focusing on misdeployment and systematic review of the current literature

Abstract

Background Gastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Surgical gastroenterostomy and enteral endoscopic stenting have represented effective therapeutic options, although recently endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stent (LAMS) is spreading improving the outcome of this condition. However, this procedure, although mini-invasive, is burdened with not negligible complications, including misdeployment. Main body We report the case of a 60-year-old male with gastric outlet obstruction who underwent ultrasound-guided gastroenterostomy using LAMS. The procedure was complicated by LAMS misdeployment being managed by laparoscopy-assisted placement of a second LAMS. We performed a systematic review in order to identify all reported cases of misdeployment in EUS-GE and their management. The literature shows that misdeployment occurs in up to 10% of all EUS-GE procedures with a wide spectrum of possible strategies of treatment. Conclusion The here reported hybrid technique may offer an innovative strategy to manage LAMS misdeployment when this occurs. Moreover, a hybrid approach may be valuable to overcome this complication, especially in early phases of training of EUS-guided gastroenterostomy.

Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management

“…In EUS-BD, stent misdeployment may be associated with spillage of bile and secretions into the peritoneal cavity or retroperitoneal space, resulting in peritonitis and pneumoretroperitoneum[ 90 ]. Recently Fabbri et al [ 91 ] proposed a classification of misdeployment types during EUS-guided gastroenterostomy as follows: Proximal flange misdeployment, distal flange misdeployment, stent misdeployment perforating other organs, and stent misdeployment into the peritoneum. This model considers which flange is misdeployed and the anatomical localization of the stent after misdeployment and can be supposedly adopted for all EUS-guided procedures involving the use of LAMS.…”

Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy

“…An additional alternative salvage treatment in cases of SM was proposed by Fabbri et al The authors performed a laparoscopic-assisted EUS-guided gastroenterostomy [47].…”