Management of afferent limb obstruction by EUS-guided jejunojejunostomy and placement of LAMS

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). …

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Endoscopic replacement technique for migrated LAMS during endoscopic pancreatic necrosectomy

Post written by Mitsuru Okuno, MD, PhD, from the Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan. EUS-guided drainage of walled-off necrosis (WON) is the accepted efficient and safe standard of care. The LAMS has a large lumen (up to 10 mm) and dual flanges that tightly adhere the LAMS to the fistula within the …

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Rescue of a delayed spontaneously migrated lumen-apposing metal stent placed to facilitate transluminal ERCP

Post written by Prabhleen Chahal, MD, FACG, FASGE, and C. Roberto Simons-Linares, MD, MSc, from the Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. We present a case of a delayed spontaneously migrated lumen-apposing metal stent (LAMS) that was placed in a patient with a history of Roux-en-Y gastric bypass …

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EUS-guided cystesophagostomy using a LAMS for drainage of a pancreatic fluid collection in a pediatric patient

Post written by Ryan Law, DO, from the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA. An 8-year-old boy was referred for abdominal pain of unclear etiology, dysphagia, and failure to thrive. He had multiple visits to the emergency room over a 5-year period for abdominal pain of unclear etiology. After routine evaluation …

Continue reading EUS-guided cystesophagostomy using a LAMS for drainage of a pancreatic fluid collection in a pediatric patient

Retrieval and redeployment of migrated LAMS to facilitate endoscopic necrosectomy of walled-off necrosis

Post written by Shashideep Singhal, MD, FASGE, from the Gastrointestinal Care Consultants, Houston, Texas, USA.                  Walled-off necrosis (WON) develops as a sequel to acute pancreatitis. Approximately 15% of patients with acute pancreatitis can experience WON. EUS-guided transmural drainage of WON has been a safe, efficacious, and widely used therapeutic modality in recent times. The …

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Safety and efficacy of lumen-apposing metal stents with and without simultaneous double-pigtail plastic stents

Post written by Kulwinder S. Dua, MD, FASGE, FACP, FRCP, from the Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, USA. Lumen-apposing metal stents (LAMSs) have a large internal diameter and hence are routinely used to manage walled-off pancreatic necrosis. Secondary to their simplicity in deployment as a single-step procedure, LAMSs are also …

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Management of an esophagojejunal anastomotic stricture using a LAMS

Post written by Ryan Law, DO, from the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA. We present a 56-year-old woman with history of lupus and laparoscopic Roux-en-Y gastric bypass (RYGB), complicated by a persistent anastomotic ulcer ultimately requiring partial gastrectomy and esophagojejunostomy who was referred for endoscopic management of an esophagojejunal (EJ) …

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