P1128 - Use of Endoscope Attachment to Improve Pyloric Visualization in Malignant Gastric Outlet Obstruction

Tyler B. Fugere, MD¹, Adam J. Goodman, MD^2
1New York University Langone Health, Staten Island, NY; ²NYU Grossman School of Medicine, Brooklyn, NY

Introduction: Gastric outlet obstruction is a potential complication of gastric and pancreatic malignancies, characterized by a distended abdomen and food retention. Stenting is a common treatment, with a shorter hospital stay compared to surgery. To visualize the stomach, decompression with a nasogastric tube is frequently needed, as a standard endoscope may not be able to clear the stomach contents. Endoscope attachments, such as the Motus Pure-Vu EVS System, can remove larger amounts of retained gastric contents, improving procedure success.

Case Description/Methods: This case involves a 74-year-old male recently diagnosed with gastric adenocarcinoma who presents with abdominal distension. On the day prior to hospital presentation, a PET CT scan revealed circumferential involvement of his adenocarcinoma around the pylorus, resulting in gastric outlet obstruction. Due to this finding, he was sent to the emergency room for evaluation and potential intervention. While decompression with a nasogastric tube was recommended, the patient was unable to tolerate it. Subsequently, an endoscopy was performed, revealing a stomach filled with solid food and liquid. The adenocarcinoma was partially visualized in the pre-pyloric antral area, and the scope could not be advanced past the malignancy. Additionally, the pylorus was not visible for stent deployment. To aid visualization of the pylorus, the Motus Pure-Vu EVS System was used to remove enough stomach contents through its larger suction channel. At this point, a duodenal stent was successfully deployed. The patient was then transferred to the medicine floor and started on a pureed diet.

Discussion: The use of the Motus Pure-Vu EVS System facilitated successful stent deployment through the pylorus in this patient, leading to an improvement in symptoms caused by the gastric outlet obstruction. This product has six times the suction area of standard gastroscopes, allowing for greater removal of gastric content. Choosing to proceed with endoscopy using this system led to timely care with fewer potential complications. The patient did not require repeat nasogastric tube decompression, which was initially intolerable, and was able to avoid undergoing another endoscopic procedure. With the stent in place, the patient was discharged and began chemotherapy.

Grammarly was used in the editing of this abstract.


Disclosures:


Tyler B. Fugere, MD¹, Adam J. Goodman, MD². P1128 - Use of Endoscope Attachment to Improve Pyloric Visualization in Malignant Gastric Outlet Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.