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We report the case of a 58-year-old man who had undergone gastric resection with end-to-side gastrojejunostomy and Roux-en-Y reconstruction because of gastric cancer 9 months previously. During follow-up he experienced epigastric postprandial pain and recurrent vomiting. Endoscopy revealed kinking of the efferent jejunal loop at the site of the gastrojejunostomy, which caused food retention in the remaining parts of the stomach and in a dilated blind loop (Figs. 1 and 2). For treatment of the obstructed/kinked efferent loop, we decided to perform endoscopic jejunojejunostomy using a lumen-apposing stent (LAS), the AXIOS stent (Boston Scientific, Marlborough, Mass) (Video 1, available online at www.VideoGIE.org). The kinked efferent loop therefore was endoscopically (GIF H 180J; Olympus, Hamburg, Germany) intubated, and a filled 20-mm CRE balloon catheter (Boston Scientific) was placed in the efferent loop. Then an EUS endoscope (GF-UCT-180; Olympus) was inserted into the blind loop, and the filled balloon catheter in the efferent loop was visualized on EUS (Fig. 3) and served as a target for EUS-guided puncture (Fig. 4) of the

videogie

Endoscopic jejunojejunostomy by use of a lumen-apposing self-expandable metal stent for treatment of obstructed efferent loop after subtotal gastrectomy with Roux-en-Y-reconstruction