Gastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Surgical gastroenterostomy and enteral endoscopic stenting have represented effective therapeutic options, although recently endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stent (LAMS) is spreading improving the outcome of this condition. However, this procedure, although mini-invasive, is burdened with not negligible complications, including misdeployment. We report the case of a 60-year-old male with gastric outlet obstruction who underwent ultrasound-guided gastroenterostomy using LAMS. The procedure was complicated by LAMS misdeployment being managed by laparoscopy-assisted placement of a second LAMS. We performed a systematic review in order to identify all reported cases of misdeployment in EUS-GE and their management. The literature shows that misdeployment occurs in up to 10% of all EUS-GE procedures with a wide spectrum of possible strategies of treatment. The here reported hybrid technique may offer an innovative strategy to manage LAMS misdeployment when this occurs. Moreover, a hybrid approach may be valuable to overcome this complication, especially in early phases of training of EUS-guided gastroenterostomy.

中文翻译：

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使用内腔金属支架的混合胃肠造口术：一个侧重于错误部署的病例报告和对当前文献的系统评价

胃出口梗阻可由多种良性和恶性疾病引起，特别是胃、十二指肠或胰腺肿瘤。外科胃肠造口术和肠内镜下支架术代表了有效的治疗选择，尽管最近使用内腔并置金属支架 (LAMS) 的内镜超声引导下胃肠道造口术正在普及，以改善这种情况的结果。然而，这个过程虽然是微创的，但会带来不可忽视的并发症，包括部署不当。我们报告了一例 60 岁男性胃出口梗阻，他使用 LAMS 进行了超声引导下的胃肠造口术。该过程因 LAMS 错误部署而变得复杂，该错误部署由腹腔镜辅助放置第二个 LAMS 进行管理。我们进行了系统审查，以确定所有报告的 EUS-GE 及其管理中的错误部署案例。文献表明，多达 10% 的 EUS-GE 程序发生了错误部署，并具有广泛的可能治疗策略。此处报道的混合技术可能会提供一种创新策略来管理 LAMS 的错误部署。此外，混合方法可能对克服这种并发症很有价值，特别是在 EUS 引导的胃肠造口术培训的早期阶段。