Endoscopic ultrasound-guided gastroenterostomy using a novel dumbbell-shaped fully covered metal stent for afferent loop syndrome with long interluminal distance

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) (Hot Axios; Boston Scientific, USA) effectively manages afferent loop syndrome [1] [2]. The LAMS prevents stent migration and fluid leakage. However, because the distance between the flanges of the LAMS is 10 mm, if the distance between the afferent limb and the stomach increases beyond this distance, the risk of technical failure and complications increases [3].