Published online Jun 16, 2018. doi: 10.4253/wjge.v10.i6.117
Peer-review started: January 12, 2018
First decision: March 7, 2018
Revised: March 30, 2018
Accepted: April 19, 2018
Article in press: April 19, 2018
Published online: June 16, 2018
Processing time: 154 Days and 7.8 Hours
Our patient’s main reported symptoms were weakness, fatigue and a 50-pound weight loss.
On esophagogastroduodenoscopy (EGD) patient was found to have a gastro-jejunal (GJ) anastomotic stricture.
A careful endoscopic evaluation is necessary to exclude alternative diagnosis such as marginal ulcer and gastro-gastric fistula which can present with similar symptoms.
Main laboratory testing for GJ anastomotic stricture involves checking for Helicobacter Pylori through hydrogen breath test, serology, stool antigen test or microscopic examination of obtained tissue during EGD.
No imaging techniques were used in diagnosis and management of this case though an upper gastrointestinal series can be performed to diagnosis GJ anastomotic stricture/stenosis.
No Helicobacter pylori organisms were found on microscopic examination of specimens obtained during EGD.
Lumen apposing metal stent (LAMS) was deployed in GJ anastomotic stricture during EGD while patient was continued on daily proton pump inhibitor orally.
The term “Hydrogen-potassium ATPase inhibitor” mentioned in this case report is more commonly known as “proton pump inhibitor”.
The newer LAMS is a safe and effective option for management of GJ anastomotic stricture and provides us with an alternative to fully covered self-expanding metal stent.