Aims/Purpose: Guidelines recommend treating benign gastric outlet obstruction with serial balloon dilations. However, dilation has usually a transient effect. Self-expanding metal stent (SEMS) placement is a valid alternative, but the rate of migration is high, especially when the stenosis is short. We present a case of a prepyloric stenosis from caustic ingestion treated by balloon dilation followed by lumen-apposing metal stent (LAMS) placement during the same session.

Methods: Three months after caustic ingestion, a 66 year old patient developed a gastric outlet obstruction syndrome. EGD showed a stomach filled by solid/liquid contents and a tight, prepyloric stenosis. After prolonged starving and drainage by naso-gastric tube, EGD was repeated, and confirmed the prepyloric stricture, which allowed only the passage of a guidewire-assisted catheter. Contrast injection and fluoroscopy showed that the length of the stenosis was about 10 mm. A wire and balloon were advanced and pneumatic dilation up to 15 mm was performed with good effect. Subsequently, we decided to deploy a 15x10 mm LAMS through the dilated stricture and was anchored to the surrounding gastric mucosa by application of two metallic clips. The scope was then able to be passed easily into the duodenum.

Results: We observed almost immediate symptom resolution and the patient was able to tolerate a liquid diet from day 1 and a solid diet from day 3. No further episodes of vomiting occurred. On follow-up contrast radiography after 48 hours, smooth gastric contrast emptying into the duodenum through the prepyloric stent was observed. Follow up EGD was performed after one week and the LAMS was correctly in place and easily passable with the endoscope.

Conclusion: LAMS placement is being performed for an increasing number of clinical benign and malignant conditions. Our clinical case describing an off-label use of LAMS suggests that this type of stent may be a valuable option for a benign short stricture due to its short length and wide flanges, which could reduce the risk of migration.