E0459 - Endoscopic GJ With LAMS for Preoperative Nutrition in Neoplastic Gastric Outlet Obstruction

David Cheung, MD¹, Vamsi Vemireddy, MD², Peter H. Nguyen, MD³, Amirali Tavangar, MD², James Han, MD⁴, Jason Samarasena, MD, MBA, FACG^4
1UCI Medical Center, Orange, CA; ²University of California Irvine, Orange, CA; ³University of California, Irvine, Orange, CA; ⁴UC Irvine, Orange, CA

Introduction: Malignant gastric outlet obstruction resulting from gastric cancer can prevent adequate oral intake and lead to malnutrition. Optimization of preoperative nutrition improves postsurgical outcomes and increases overall survival. Duodenal stenting is a common method of bypassing the obstruction; however, for patients with near obstruction of the gastric outlet, novel techniques may be needed. Here we present a case of post pyloric malignant gastric outlet obstruction that was bypassed by creating a gastrojejunostomy with lumen-apposing metal stent (LAMS).

Case Description/Methods: A 79-year-old male presented for a 2-month history of nausea, vomiting, abdominal pain, weight loss. A prior endoscopy showed evidence of gastric outlet obstruction due to poorly differentiated metastatic gastric adenocarcinoma with signet ring features at the pylorus. Prior to starting neoadjuvant chemotherapy, the patient was referred to our facility for placement of a duodenal stent. Upon evaluation, the patient was a good candidate to trial gastrojejunostomy (GJ) w/ LAMS. With water used as an acoustic interface to distend the distal duodenum and proximal jejunum, an ultrasound-guided gastrojejunostomy was created using a 20-mm electrocautery-enhanced lumen-apposing metal stent (LAMS) [Figure 1. The patient tolerated the procedure well and there were no complications. He was able to advance his diet, gain 15 lbs of weight, and obtain chemotherapy. Four months after GJ placement and chemotherapy, EGD showed presumed resolution of gastric adenocarcinoma and post pyloric obstruction. Six months after, the patient underwent curative subtotal gastrectomy with removal of the LAMS at the time of the operation.

Discussion: LAMS were initially designed for transgastric or transduodenal endoscopic drainage of pancreatic pseudocyst or walled off necrosis. Here we present a case of successful deployment of a LAMS to create an endoscopic GJ for nutritional support as a bridge to curative subtotal gastrectomy. Endoscopic GJ is typically used in palliative cases were surgery is not planned. In this case, the surgeon was able to remove the LAMS at the time of surgery. This case highlights GJ w/ LAMS as an alternative solution to duodenal stenting or surgical J tube for malignant gastric outlet obstruction and its utilization in nutritional support.



Disclosures:


David Cheung, MD¹, Vamsi Vemireddy, MD², Peter H. Nguyen, MD³, Amirali Tavangar, MD², James Han, MD⁴, Jason Samarasena, MD, MBA, FACG⁴. E0459 - Endoscopic GJ With LAMS for Preoperative Nutrition in Neoplastic Gastric Outlet Obstruction, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.