A 64-years-old male with a well-differentiated duodenal neuroendocrine tumor of grade 2 was referred to our center because of an inferior vena cava occlusion. An endovascular metal stenting was performed (Fig. 1a, blue arrow). Four days later, he developed an intestinal obstruction due to vascular stent compression in the duodenum. A 12-cm uncovered duodenal self-expandable metal stent was successfully placed (Fig. 1a, left red arrow), but the patient had a persistent gastric outlet obstruction due to the compression of the distal duodenum.
(a) Fluoroscopy during endoscopic ultrasound guided gastrojejunostomy (right red arrow) in a patient with previous uncovered duodenal self-expandable metal stent (left red arrow) and endovascular stent (blue arrow). (b) Endoscopic image of the lumen-apposing metal stent. (c) Ulcerative jejunitis.
Thus, an endoscopic ultrasound-guided gastrojejunostomy using a 20mm lumen apposing metal stent (HotAxios, Boston Scientific, Voisins-le-Bretonneux, France) was decided (Fig. 1a, right red arrow).1 The procedure occurred without complications and the patient recovered well, with oral solid diet.
One week later he presented with melena and anemia. An upper-GI endoscopy showed no gastric bleeding source. However, multiple circumferential ulcers (Fig. 1c) were found in the jejunal lumen near to the gastrojejunostomy (Fig. 1b). This ulcerative jejunitis lead to the diagnosis of a Zollinger-Ellison syndrome.2 A treatment with double dose prompt pump inhibitors was started with clinical improvement. The patient was discharged, and no bleeding recurrence or reintervention was observed for two months follow-up.
Conflict of interestNone.
