LAUSR

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumenapposing metal stent (LAMS) is a novel endoscopic technique for treating gastric outlet obstruction and represents an alternative to stenting or surgery [1, 2]. EUS-GE is minimally invasive and compares favorably with long-term surgical outcomes [1, 2]. Several studies report a high degree of technical and clinical success, despite a considerable rate of complications [1, 3]. A 65-year-old woman with generalized breast cancer presented with signs of gastric outlet obstruction, with a tight duodenal stenosis caused by malignant abdominal lymphadenopathy. EUS-GE was performed using LAMS (20mm Hot Axios Stent; Boston Scientific, Marlborough, Massachusetts, USA), resulting in immediate resumption of oral intake (▶Fig. 1, ▶Video 1). Correct positioning of the stent in the small intestine was documented endoscopically and radiologically. However, 4 months later, the patient complained of dyspeptic symptoms. Gastroscopy was performed, revealing a normal anastomosis with two jejunal loops (▶Fig. 2, ▶Video 1). Then, 2 months later, gradual development of anorexia, diarrhea, and fecal vomiting was observed. A computed tomography scan indicated possible communication of the stent with the colon (▶Fig. 3, ▶Video 1). Gastroscopy showed a patent anastomosis between the stomach and jejunum as well as the large intestine. We extracted E-Videos