Post written by Hassan Ghoz, MD, and Victoria Gómez, MD, from the Division of Gastroenterology and Hepatology, Section of Advanced Endoscopy, Mayo Clinic, Jacksonville, Florida, USA.

We describe a case of a patient presenting with malignant afferent loop obstruction (ALO) which we managed using EUS-guided creation of a jejunojejunostomy with a lumen-apposing metal stent (LAMS). Our patient had a history of a diverting loop gastro-jejunostomy due to an obstructing mesenteric desmoid tumor and a recent diagnosis of metastatic adenocarcinoma which failed chemotherapy. Our procedure was performed for palliative purposes after which the patient was able to successfully advance her diet before passing away a month later.

Often times, patients with malignant ALO will have poor performance statuses, and surgical management wouldn’t be a viable treatment option and endoscopic strategies become the therapy of choice. In those cases, endoscopic therapy needs to be individualized based on anatomy and extent of obstruction, such as in our case in which we elected to use a hybrid endoscopic technique utilizing EUS, fluoroscopy, and LAMS given the patient’s anatomical configuration.

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