Palliative use of lumen-apposing metal stents in tandem to alleviate malignant bowel obstructions in a patient with small-bowel adenocarcinoma with carcinomatosis

Background and Aims: Duodenal stents or endoscopic gastrojejunostomy with lumen-apposing metal stents (LAMSs) are commonly used to treat small-bowel obstruction. However, endoscopic therapy for many regions of obstruction is less well-established. We describe a patient case with multiple areas of obstruction that was relieved with LAMS placement, creating gastroenteric and enteroenteric anastomosis. Methods: Direct endoscopy with EUS was used to place gastroenteric LAMSs. A multimodal imaging approach, including EUS, fluoroscopy, and transabdominal ultrasound, was used to identify the area of the enteroenteric LAMS. Lastly, a venting percutaneous jejunostomy tube was placed using the transluminal technique. Results: Tandem LAMS placement successfully decompressed the small bowel with improved oral intake. The patient did not require any hospital readmissions related to the stents. Conclusions: LAMS placement may be helpful for patients with multiple small-bowel obstructions, especially for patients who are not candidates for surgical intervention to alleviate their symptoms.