Endoscopic Ultrasound-Guided Gastrojejunostomy for Superior Mesenteric Artery Syndrome Secondary to Rapid Weight Loss

Abstract

A 19-year-old man diagnosed with diffuse large B-cell lymphoma undergoing chemotherapy presented for recurrent emesis and weight loss. Imaging studies of the abdomen demonstrated features of superior mesenteric artery syndrome. The patient deferred conservative treatment options and was deemed not to be a surgical candidate. Endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing metal stent was performed to bypass the obstruction. Subsequently, the patient's oral intake and weight significantly improved. The stent was removed 6 months after placement with resolution of superior mesenteric artery syndrome symptoms.

Acute superior mesenteric artery syndrome complicated by severe gastric, pancreatic and renal ischaemia

“…While our patient denied subclinical SMAS prior to his acute presentation, it is likely that the extensive oral fluid intake prior to evaluation contributed to the severity of his presentation. Other cases of acute SMAS following substantial oral intake have also been reported 29 32…”

“…Our patient reported a subjective history of rapid growth without significant weight gain, potentially predisposing him to the development of SMAS. Additionally, SMAS has been observed in patients following surgical correction of a spinal deformity or spinal trauma; this is hypothesised to occur due to shortening of the aortomesenteric distance and angle with spinal fixation postural changes 27–30. While the association is unclear, SMAS occurs most frequently in young females, with a median age of 23 1 29.…”

“…Additionally, SMAS has been observed in patients following surgical correction of a spinal deformity or spinal trauma; this is hypothesised to occur due to shortening of the aortomesenteric distance and angle with spinal fixation postural changes 27–30. While the association is unclear, SMAS occurs most frequently in young females, with a median age of 23 1 29. However, virtually, any event or condition that decreases the aortomesenteric angle has the theoretical potential to contribute to SMAS.…”

Food Insecurity Leading to Superior Mesenteric Artery Syndrome Managed Successfully with Endoscopic Gastrojejunostomy Stent

“…This technique has been shown safe and effective for treatment of both benign and malignant causes of gastric outlet obstruction [ 27 , 28 ]. Only recently has this procedure been employed as a management strategy for SMA syndrome, with only a few published cases available in the literature [ 29 – 33 ]. The success of the procedure in our patient adds to the body of evidence supporting its efficacy and safety profile for this patient population.…”