Endoscopic management of gastric outlet obstruction of remnant stomach in a patient with Roux-en-Y gastric bypass

Abstract

Luminal stent placement for malignant gastric outlet obstruction is an efficacious alternative to surgical bypass in patients with advanced malignancy and limited life expectancy. Altered surgical anatomy, especially Roux-en-Y gastric bypass (RYGB) anatomy, can make endoscopic intervention challenging. EUS-guided access to the remnant stomach using a lumen-apposing metal stent (LAMS), recently termed gastric access temporary for endoscopy (GATE), has been used to perform endoscopic submucosal dissection, EUS-guided tissue sampling, and various pancreaticobiliary interventions. We present a case using a variant of the GATE technique to allow endoscopic palliation of malignant gastric outlet obstruction of the remnant stomach (Video 1, available online at www.VideoGIE.org).