LAUSR

An 88-year-old man with a history of extensive cardiovascular co-morbidities was admitted to our tertiary center following prolonged vomiting, anorexia, and upper abdominal pain. He had lost 10 kilograms over the course of 4 months as a result. An abdominal computed tomography (CT) scan was performed to rule out neoplasia. Surprisingly, the scan revealed extensive gastroduodenal distention and a high-grade stenosis of the third part of the duodenum (D3) caused by extrinsic compression by the superior mesenteric artery (▶Fig. 1, arrow). Furthermore, a significantly reduced aortomesenteric angle was identified (9.1°, normal: 25–60°) (▶Fig. 2); these findings are compatible with superior mesenteric artery syndrome [1]. Nasogastric tube decompression and parenteral feeding were commenced, resulting in only temporary relief of symptoms. Unfortunately, endoscopic placement of a nasojejunal feeding tube also failed. Only very recently has endoscopic ultrasound (EUS)-guided gastroenterostomy also been evaluated in the context of a benign gastric outlet obstruction [2, 3]. Because our patient was deemed unfit to undergo surgery, this technique was proposed to the patient and his family, who consented to the procedure. Under endoscopic and fluoroscopic guidance, a 0.035-inch guidewire was advanced through the extrinsic stenosis of D3 (▶Fig. 3) and subsequently exchanged for a nasobiliary catheter. Water was infused into the jejunum (▶Video 1), dilating the latter and facilitating visualization on EUS (▶Fig. 4). Lastly, a 20× 10-mm lumen-apposing metal stent E-Videos