PMC4713186_01
Contrast study demonstrating the stricture. b Endoscopic view of the stricture. c The proximal flange was opened inside the gastric antrum. d At 3-month follow-up, the stent was easily removed by grasping the proximal end with a rat-tooth forceps.
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An upper gastrointestinal series demonstrated a short stricture of the pyloric channel which could not be traversed endoscopically (Fig. 2 a, Fig. 2 b). Under fluoroscopic guidance, a LA-SEMS was deployed across the pyloric stenosis and dilated to 15 mm (Fig. 2 c). Her symptoms resolved, and the stent was removed endoscopically 3 months later (Fig. 2 d).
PMC4713186_02
Contrast-study demonstrating the anastomotic stricture. b Endoscopic view of the stricture. c The distal flange of the stent was partially opened inside the Roux limb stricture. d To fully bridge the 4-cm ischemic stricture, a second stent was placed inside the first one, with the distal flange of the stent in the jejunum and the proximal flange inside the lumen of the first stent. e A follow-up upper gastrointestinal series after 6 weeks showed a widely patent gastrojejunostomy with free flow of contrast to the Roux limb. f Endoscopic view demonstrating excellent stent position at follow-up endoscopy.
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Esophagogastroduodenoscopy (EGD) showed a 4-cm long anastomotic stricture ( Fig. 3 a, Fig. 3 b). An LA-SEMS was placed with the proximal flange in the gastric pouch, and the distal flange partially opened within the stricture ( Fig. 3 c). To fully bridge the long stricture, a second LA-SEMS stent was placed in an overlapping fashion (Fig. 3 d), and both stents were dilated to 15 mm. A follow-up upper gastrointestinal series and EGD at 6 weeks showed a widely patent gastrojejunostomy with excellent stent position (Fig. 3 e, Fig. 3 f).
PMC4713186_03
Contrast study demonstrating anastomotic leak at the gastric vertical staple line and complete gastrojejunostomy stricture. b Rendezvous endoscopic approach with single-balloon enteroscope inserted via the excluded stomach. c The echolinear EUS scope was simultaneously advanced to the gastric pouch. d Lumen-apposing, double-flanged, fully-covered SEMS, 15 mm in diameter, was deployed to create a new gastrojejunal anastomosis. e Contrast injection showing excellent seal of this newly created anastomosis with good flow of contrast into the Roux limb. f Stent endoscopically removed at 8 weeks demonstrating well-healed patent anastomosis.
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EGD showed an edematous gastric pouch and complete anastomotic stenosis precluding access to the jejunum (Fig. 4 a). A single-balloon enteroscope was inserted into the excluded distal stomach via an existing gastrostomy tube, and advanced in a retrograde fashion to the anastomosis (Fig. 4 b). A LA-SEMS was placed to create a new gastrojejunal anastomosis (Fig. 4 c, Fig. 4 d). A contrast study showed no extravasation (Fig. 4 e). The LA-SEMS was removed at 8 weeks (Fig. 4 f).
PMC4713186_04
Short, tight, benign gastroduodenal stricture. b, c Endoscopic view of lumen-apposing, double-flanged, fully covered SEMS in the pyloric channel. d Stent lumen dilated to an internal diameter of 12 mm using a wire-guided hydrostatic dilation balloon.
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EBD. EGD revealed a short pyloric stricture, with a luminal diameter of less than 1 mm (Fig. 5 a). A LA-SEMS was placed and the stent lumen was dilated to 12 mm (Fig. 5 b,Fig. 5 c, Fig. 5 d).
PMC4713186_05
Endoscopic view of the tight anastomotic stricture. b Fluoroscopic image showing guidewire placement before stent deployment. c Endoscopic view of the proximal stent flange immediately after deployment. d Final stent position after balloon dilation of the SEMS lumen to 12 mm.
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Colonoscopy revealed a severely narrowed, short stricture at the anastomotic site (Fig. 6 a). We opted to place a LA-SEMS, since a longer stent would potentially have a higher likelihood of migration and cause excessive patient discomfort due to stent proximity to the anal verge (Fig. 6 b, Fig. 6 c). The lumen of the stent was dilated up to 12 mm (Fig. 6 d).