ENDOSCOPIC MANAGEMENT OF EDEMATOUS GASTRO-JEJUNAL ANASTOMOTIC STENOSIS drperezturrent@gmail.com

PE012

ENDOSCOPIC MANAGEMENT OF EDEMATOUS GASTRO-JEJUNAL ANASTOMOTIC STENOSIS

4

Mexico

Poster Exhibition only

Laparoscopic gastrectomy is widely recognized as the gold standard for gastric cancer. While generally safe, anastomotic obstruction occurs in up to 22% of cases, with edematous anastomotic stenosis (EAS) representing only 1.5%. Optimal management remains undefined, and most strategies involve repeated interventions or direct manipulation of a recent anastomosis, increasing the risk of complications.

We report a novel combined approach using a fully covered self-expanding metal stent (FCSEMS) and systemic steroids for acute postoperative EAS. A 40-year-old male underwent laparoscopic Roux-en-Y partial gastrectomy for a 5×4 cm subepithelial tumor. Intraoperative leak tests were negative, and oral intake resumed on postoperative day (POD) 4.

On POD 5, the patient developed vomiting and gastric distension. Imaging confirmed gastric outlet obstruction. Endoscopy revealed severe anastomotic edema causing stenosis but allowing scope passage. A FCSEMS was placed with a nasojejunal tube for anchorage, followed by a single 100 mg IV hydrocortisone dose and transition to oral prednisone 25 mg/day. Oral intake restarted on POD 6, and the patient was discharged on POD 10. Prednisone was tapered and discontinued by POD 14, when endoscopy confirmed complete resolution and stent removal. No recurrence occurred during follow-up.

This case demonstrates that combining FCSEMS with systemic steroids can achieve rapid symptom resolution, early oral intake, and short hospitalization in EAS, while avoiding repeated balloon dilations and minimizing anastomotic trauma. This minimally invasive, single-intervention strategy may represent a valuable alternative for early postoperative EAS, warranting further prospective evaluation.