Background: Lumen-apposing metal stents (LAMSs) have emerged as a versatile tool for managing various gastrointestinal conditions, including post-surgical complications. This case report describes the successful use of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) with lumen apposing metallic stent (LAMS) placement to treat efferent limb syndrome (ELS) causing gastric outlet obstruction (GOO) in a patient with altered anatomy after a Whipple procedure. Case Presentation: An 83-year-old female with a history of pancreatic adenocarcinoma status-post Whipple procedure presented with symptoms of GOO one year after surgery. Imaging and endoscopy revealed acute angulation at the efferent limb take-off resulting in mechanical obstruction of the gastrojejunal anastomosis (GJ) without evidence of malignancy. The patient was also found to have ascites concerning for a recurrent pancreatic malignancy. Due to the patient’s age and poor surgical candidacy, an EUS-GJ was successfully performed using a 20×10 mm cautery-enhanced LAMS bypassing the obstruction in the efferent limb and resulting in immediate symptom relief. The patient gained weight and remained clinically well with no procedural related complications after a 30-day follow-up. Conclusion: This case highlights the potential of EUS-GJ as an effective, minimally invasive technique for managing complex post-surgical complications in patients with altered anatomy. The technique resulted in symptom resolution while minimizing morbidity and recovery time. In patients with disease progression, EUS-GJ should be considered for the palliation of GOO caused by efferent limb syndrome on a case-by-case basis after multidisciplinary discussion with surgery.
Habib et al. (2026) studied this question.