Salvaging a Transcolonic EUS-Gastroenterostomy Misdeployment With a Stent-in-Stent Technique: GIE | August 2026

Conventional Method:

EUS-guided gastroenterostomy (EUS-GE) creates a bypass between the stomach and jejunum using a lumen-apposing metal stent (LAMS) for malignant gastric outlet obstruction. Successful deployment requires a clear puncture pathway without intervening bowel loops.

Why was a New Rescue Method Required?

During EUS-GE in this patient, an unsuspected transverse colon loop was interposed between the stomach and jejunum. The LAMS traversed both walls of the colon before entering the jejunum—a type V misdeployment. The LAMS subsequently migrated into the colon, leaving a mature colojejunal fistulous tract and a complex gastro-colo-jejunal pathway.

Surgical revision would have been high risk, prompting an endoscopic salvage strategy.

The New Technique:

A 20-mm partially covered tubular enteral metal stent was deployed through the existing 20-mm LAMS and advanced transcolonically into the jejunum. Matching the stent diameters created a tight stent-in-stent seal.

The covered portion effectively excluded the intervening colonic lumen, minimizing food entry into the colon and fecal reflux into the stomach, while maintaining a wide gastrojejunal conduit. The uncovered distal jejunal segment provided tissue anchoring and reduced migration risk.

The patient resumed a soft diet, was discharged within 72 hours, and maintained oral intake at 1-year follow-up.

Clinical Utility:

This case demonstrates that selected EUS-GE misdeployments may be salvaged endoscopically without surgery, provided the patient is stable, there is no peritoneal contamination, and a mature tract has developed.

The major preventive lesson is equally important: during EUS-GE, operators should inspect the entire needle-to-target trajectory for interposed bowel, rather than concentrating solely on the intended jejunal landing site.

Bottom Line:

Type V EUS-GE misdeployment occurs when an interposed collapsed bowel loop—particularly colon—is transfixed during LAMS deployment. In carefully selected stable patients with a mature tract, a matching-diameter partially covered enteral stent placed through the LAMS may reconstruct the gastroenterostomy and avoid high-risk surgical revision.