P4985 - Recurrent Duodenal Stenosis in a Down Syndrome Patient Treated With Lumen-Apposing Metal Stent Placement

Shawn Philip, DO, Nazir Ahmed, MD, Shil Patel, DO, Rosario Ligresti, MD
Hackensack University Medical Center, Hackensack, NJ

Introduction: Duodenal stenosis and other upper gastrointestinal abnormalities are a common anomaly in the Down Syndrome population. Duodenal stricturing can also occur in the setting of malignancy, peptic ulcer disease, or after surgery. We present a case of recurrent duodenal stricture formation in an adult patient with Down syndrome who has had prior duodenoduodenostomy for duodenal stricturing ten years prior.

Case Description/Methods: A 32 y/o male with PMH of down syndrome, GERD, duodenal stenosis s/p duodenoduodenostomy ten years prior, and EOE presented with complaints of diminished appetite and fatigue with occasional vomiting. Patient has been followed by a gastroenterologist in the past and underwent upper endoscopy five months prior showing gastritis with friable mucosa in the duodenal bulb. Patient underwent subsequent endoscopy a month prior given persistent symptoms which showed dilation of the stomach, food bolus in the stomach, and severe friable mucosa. A stricture was noted in the second portion of the duodenum which could not be traversed by both standard upper endoscope and pediatric colonoscope. Patient was discharged on a proton pump-inhibitor twice daily. He again underwent EGD one month after this showing a benign- appearing intrinsic severe stenosis in the duodenum. This was stented with a 10 x 15 mm lumen-apposing metal stent under fluoroscopic guidance. Under fluoroscopic guidance, a 4-6 mm balloon through the scope was utilized to dilate the stent. Biopsies were taken showing chronic lamina chronic inflammation with negative Helicobacter Pylori immunostaining. The patient was continued on a proton pump inhibitor twice daily with improvement in symptoms with a plan for a repeat endoscopy in two months.

Discussion: Duodenal stenosis is a major issue in the pediatric population with Down Syndrome. Despite surgery, it is possible for stricturing to occur again. Lumen-apposing metal stent placement is becoming commonly used with benign gastrointestinal strictures however to our knowledge this is the first use in CIDO (congenital intrinsic duodenal obstruction) in the setting of Down syndrome.


Disclosures:


Shawn Philip, DO, Nazir Ahmed, MD, Shil Patel, DO, Rosario Ligresti, MD. P4985 - Recurrent Duodenal Stenosis in a Down Syndrome Patient Treated With Lumen-Apposing Metal Stent Placement, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.