Patients with peritoneal carcinomatosis frequently develop small bowel obstruction (SBO), resulting in significant morbidity due to severe nausea, vomiting, pain, leading to reduced quality of life. Surgical bypass or ostomy creation is the traditional approach; however, obstructions proximal to the ostomy or bypass can recur. Further treatment becomes difficult, especially in patients with low performance status not amenable to surgery. In this setting, endoscopic ultrasound–guided enteroenterostomy (EUS-EE) using a cautery-enhanced (CE) Lumen-apposing metal stent (LAMS) through a pre-existing small bowel ostomy could be a potential alternative, but data are scarce. We report two cases of patients with peritoneal carcinomatosis and recurrent malignant SBO proximal to a small bowel ostomy in whom EUS-EE was performed via the ostomy.

Case 1: a 60-year-old man with metastatic colon cancer and peritoneal carcinomatosis underwent jejunostomy for ileus two years prior. After a long stable phase under chemotherapy he presented with absent stoma output, vomiting, and melena without any oral intake. CT-scan revealed dilated small-bowel loops proximal to the ostomy, consistent with ileus. As surgery was not feasible, EUS-EE was performed by advancing a linear echoendoscope through the jejunostomy. A 15/10 mm CE-LAMS was deployed 15 cm proximal to the stoma. Subsequently stoma output improved and oral intake (soft solid) was tolerated. He was discharged after five days and died four weeks later due to disease progression.

Case 2: A 63-year-old man with metastatic pancreatic cancer and a prior ileostomy, presented with intermittent absent stoma output, abdominal pain ,and reduced oral intake. CT-scan confirmed ileus about 20 cm proximal to the stoma. An EUS-EE through the ostomy with deployment of a 20/10 mm CE-LAMS 10 cm proximal to the ostomy resulted in immediate bowel decompression. During the procedure, he aspirated gastric content, from which he fully recovered. He tolerated oral intake (full diet) for four weeks before the obstructive symptoms recurred. He declined further intervention and was discharged to hospice care.

Conclusion: These two cases suggest that EUS-guided enteroenterostomy via an existing small bowel ostomy is technically feasible. and may offer short-term palliation in carefully selected patients with recurrent malignant SBO who are not surgical candidates. Larger series are needed to better define safety, durability, and patient selection.