S6251 Gastric Outlet Obstruction Secondary to Malignant Ulceration in a Patient With Metastatic Colon Cancer: A Palliative Approach With Duodenal Stenting

Introduction: Gastric outlet obstruction (GOO) is an uncommon but clinically significant complication in patients with gastrointestinal malignancies. While primary gastric cancer is the leading malignant cause, metastasis-induced obstruction is rare. We present a unique case of malignant GOO in an elderly patient with metastatic colon cancer, managed with endoscopic duodenal stenting for palliation. Case Description/Methods: An 87-year-old man with a history of hypertension, type 2 diabetes, chronic kidney disease, coronary artery bypass graft (CABG) in 2019), and stage IV colon cancer (diagnosed March 2023, undergoing chemotherapy) presented to the Hospital following an outpatient upper endoscopy. The esophagogastroduodenoscopy showed severe esophagitis retained gastric contents, and significant ulceration in the gastric antrum with concern for GOO. The patient endorsed progressive dysphagia, early satiety, and 5-pound unintentional weight loss over the past 1.5 weeks. He denied nonsteroidal anti-inflammatory drug use or anticoagulation. Computed Tomography (CT) chest/abdomen revealed multilobar pneumonia, progressive distal gastric wall thickening, and upstream gastric dilatation. A recent liver biopsy confirmed metastatic adenocarcinoma. Given ongoing obstructive symptoms and retained gastric contents, he underwent successful endoscopic placement of a 22 mm × 90 mm uncovered duodenal self-expanding metal stent under fluoroscopic guidance, resulting in immediate drainage of gastric contents. Post-procedure, he was started on intravenous proton pump inhibitors and supportive care, and his diet was gradually advanced from clear to full liquids. Discussion: GOO in metastatic colon cancer is rare and often indicates advanced disease with limited therapeutic options. Our case emphasizes the importance of timely endoscopic evaluation and palliative intervention in symptom management. Duodenal stenting offers a minimally invasive, effective solution for malignant obstruction, improving quality of life and nutritional intake in patients unfit for surgical intervention. In selected patients with advanced malignancy, endoscopic stenting serves as a valuable tool in multidisciplinary palliative care.