S5214 High-Grade Pyloric Stenosis in Adult Causing Partial Gastric Outlet Obstruction Successfully Managed With Lumen Apposing Metal Stent (LAMS)

Introduction: Idiopathic hypertrophic pyloric stenosis (IHPS) is a relatively common congenital disorder, usually presenting within the first few weeks of birth. However, adult idiopathic hypertrophic pyloric stenosis (AIHPS) is an extremely rare entity with only handful cases reported so far in the literature. We present a rare case of AIHPS with partial gastric outlet obstruction that was successfully managed with lumen-apposing metal stent (LAMS). Case Description: A female patient in her 40s with complaints of chronic postprandial nausea, vomiting, dysphagia to solids, abdominal bloating, and discomfort initially presented to the outpatient gastroenterology office. Laboratory examination showed normal results. Barium swallow did not show any evidence of webs, rings, or strictures. The patient was admitted to our hospital for an esophagogastroduodenoscopy (EGD), which showed severe pyloric stenosis causing partial gastric outlet obstruction (GOO). Dilation up to 10 mm was then performed with simple pyloric balloon dilatation. The patient was discharged home, but her symptoms persisted without any improvement. Three weeks later, a repeat EGD was performed which revealed similar findings of high-grade pyloric stenosis and GOO. A trans-pyloric LAMS was deployed and post-dilated to 15 mm with balloon catheter. After LAMS insertion, the patient was managed supportively during hospitalization and was discharged home. The patient reported gradual improvement in her symptoms at 3-month outpatient follow up visit in the GI office and was tolerating regular solid diet well. Discussion: We present an extremely rare case of high-grade AIHPS with partial gastric outlet obstruction whose symptoms were significantly improved after endoscopic LAMS deployment. Although, currently, surgery is the preferred treatment modality, further research is warranted to compare endoscopic vs surgical techniques before finalizing a standard of care.