Post written by Michael Lajin, MD, from the Sharp Grossmont Hospital, La Mesa, California.

EUS-guided gastroenterostomy is increasingly utilized to treat gastric outlet obstruction after surgery. We describe a case of EUS-guided gastroenterostomy facilitated by extrinsic abdominal compression to treat gastric obstruction following surgical resection of a gastrointestinal stromal tumor.

A 77-year-old woman underwent laparoscopic resection of a 6-cm GIST arising from the lesser curvature. The surgery resulted in severe angulation/narrowing at the proximal gastric body. A nasobiliary drain was used to irrigate the proximal jejunum with contrast. On EUS, there was only one spot where the stomach (proximal to the stenosis) is opposed to the jejunum. Unfortunately, there was a major intervening blood vessel. After applying extrinsic abdominal compression, we were able to find a gastro-jejunostomy spot on the side of the blood vessel and a 2-cm LAMS was deployed safely. There were no adverse events after the procedure. The patient tolerated a soft diet and was discharged home. 

It was important to demonstrate that EUS-guided gastroenterostomy can be utilized to treat post-operative gastric obstruction if a target jejunal loop opposing the stomach proximal to the obstruction is identified. Extrinsic abdominal compression can facilitate avoiding major blood vessels during gastroenterostomy in situations where there is no room to find an alternative jejunal target due to anatomy.

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