Subsequent ileal stent placement for synchronous small-bowel obstruction through endoscopic ultrasound-guided ileocolostomy with a lumen-apposing metal stent

Subsequent ileal stent placement for synchronous small-bowel obstruction through endoscopic ultrasound-guided ileocolostomy with a lumen-apposing metal stent Peritoneal carcinomatosis is a severe complication of advanced gastrointestinal cancer, often leading to malignant bowel obstructions (MBOs) at multiple synchronous or metachronous points, with distressing symptoms such as frequent vomiting [1,2].Surgical management of MBO presents significant challenges in these patients [3].Here, we report a case of stepwise endoscopic management of MBO using endoscopic ultrasound (EUS)-guided ileocolostomy with a lumen-apposing metal stent (LAMS), followed by metal stent placement through the LAMS for synchronous small-bowel obstruction.A 64-year-old woman with locally advanced pancreatic cancer with multiple metastases presented with persistent vomiting owing to peritoneal carcinomatosis.Abdominal computed tomography (CT) scanning revealed marked small-bowel dilatation ( Fig. 1 a), with distal ileal obstruction ( Fig. 1 b).Given her unsuitability for surgery, an initial attempt at enteral stent placement via