Salvage reconstruction of an endoscopic ultrasound–guided gastroenterostomy using a tubular enteral stent after inadvertent transcolonic lumen-apposing metal stent deployment

Background and Aims: EUS-guided gastroenterostomy (EUS-GE) is effective for palliating malignant gastric outlet obstruction (GOO). Inadvertent gastrocolostomy, although rare, can be a serious adverse event. We present an endoscopic rescue strategy in a case of gastrocolonic and colojejunal fistula after EUS-GE. Methods: A 59-year-old woman with duodenal adenocarcinoma underwent EUS-GE with a 20- × 10-mm lumen-apposing metal stent (LAMS) because of GOO. One week later, the patient presented with postprandial diarrhea, nausea, and halitosis. Imaging and endoscopy revealed a gastrocolonic fistula and a mature colojejunal fistula. Results: Under endoscopic and fluoroscopic guidance, a partially covered self-expandable metal stent was deployed transcolonically through the LAMS into the jejunum. The procedure was uneventful. The patient resumed oral intake within 24 hours, and follow-up confirmed correct stent positioning and clinical improvement. Conclusions: Transcolonic stent placement through the LAMS appears to be a feasible rescue solution for managing inadvertent gastrocolostomy after EUS-GE in the presence of a concurrent colojejunal fistula.