S5299 Lumen-Apposing Metal Stent (LAMS) for Refractory Pyloric Stenosis: A Case Report

Introduction: Adult pyloric stenosis (PS) is commonly treated with endoscopic balloon dilation; however, some patients continue to experience symptoms despite multiple interventions. In such cases, alternative treatment options are necessary. The lumen-apposing metal stent (LAMS), initially designed for pancreatic fluid collection drainage, has shown promise in an off-label use for managing benign gastric outlet obstruction (GOO). Its dual-flanged structure and wide lumen facilitate secure placement and effective temporary decompression. Case Description: A 39-year-old man with a history of H. pylori infection complicated by pyloric stenosis and multiple endoscopic balloon dilations presented with persistent gastric outlet obstruction symptoms, including early satiety, weight loss, and postprandial vomiting. Repeat endoscopy demonstrated ongoing pyloric narrowing. Due to a lack of durable response to prior therapy and cachexia which deemed the patient not a surgical candidate, an AXIOS LAMS was placed across the pylorus to provide temporary symptomatic relief. The patient experienced immediate improvement, tolerated oral intake without difficulty, and he gained around 20 lbs in 3 months office visit. As LAMS is not intended for long-term use in benign pyloric stenosis, he was referred for elective pylorectomy, and the stent remains in place as a bridge to surgery. Discussion: This case highlights the use of LAMS as a bridge to surgery in refractory PS. While endoscopic dilation remains first-line therapy, it may not provide a long-term benefit in all patients. The unique adaptability of LAMS allows for secure deployment and short-term symptomatic relief. Its temporary use can optimize preoperative status and improve quality of life. Further guidelines and research is needed to better define the safety, durability, and long-term efficacy of LAMS in refractory PS as a bridge to surgical management.