S5197 Recurrent Ileocolonic Anastomotic Stricture Following Small Bowel Resection: Successful Palliation With EUS-Guided AXIOS Stent Placement

Introduction: Ileocolonic anastomotic strictures are a common complication after bowel surgery, often caused by inflammation, ischemia, or scar formation. While endoscopic balloon dilation is typically the first-line treatment, some strictures are recurrent or refractory, posing significant management challenges. Repeat dilations may be required, though efficacy often diminishes, and risks like perforation or bleeding increase. For patients who are poor surgical candidates or have failed conventional therapy, advanced endoscopic approaches such as stent placement offer valuable alternatives. This case highlights the successful use of a lumen-apposing metal stent (LAMS) in a patient with a recurrent ileocolonic stricture, demonstrating its safety and effectiveness in complex post-surgical cases. Case Description: A 53-year-old woman with gastroesophageal reflux disease and migraines developed recurrent bowel obstruction 1 year after small bowel resection with ileocecal anastomosis due to adhesions. Colonoscopy revealed a 3-4 mm non-traversable ileocolonic stricture, even with a pediatric scope. Biopsies from the terminal ileum and colon ruled out Crohn’s disease and other inflammatory conditions. Balloon dilation to 12 mm provided temporary relief, but placement of a fully covered self-expandable metal stent (FCSEMS) was unsuccessful due to limited scope reach. The patient presented for symptom recurrence and a therapeutic gastroscope was used to access the stricture, measuring 3-4 mm, confirmed by enterogram. A 20 mm × 10 mm LAMS was successfully placed. Fluoroscopy showed successful AXIOS stent placement, improving symptoms. The patient was advised to maintain soft stools and follow up with computed tomography enterography in 2 months; stent removal was planned after approximately 3 months. Discussion: Recurrent ileocolonic anastomotic strictures are challenging, particularly in patients with prior surgeries. Balloon dilation often offers only temporary relief, with high recurrence rates. FCSEMS placement carries risks of migration due to limited anchoring, especially in short or angulated strictures. LAMS provides superior anchorage via bilateral flanges, reducing migration risk. Although off-label in the lower gastrointestinal tract, LAMS are a promising option. In this case, LAMS placement succeeded where FCSEMS failed, offering safe, effective, and durable symptom relief. Further studies are needed to clarify their optimal role.