A Unique Case of a Successful Endoscopic Retrograde Cholangiopancreatography Through a Previously Placed Gastro-Jejunostomy Lumen Apposing Metal Stent.

Originally used for minimally invasive drainage of pancreatic fluid collections, the uses of lumen-apposing metal stents (LAMS) have expanded to encompass several other pathologies including gastric outlet obstruction, strictures, and cases with surgically altered anatomy. We describe a rare case of an endoscopic retrograde cholangiopancreatography that was successfully completed through a previously placed LAMS between the stomach and the jejunum, in a patient with challenging anatomy due to progressing malignancy resulting in gastric outlet obstruction. This case highlights the technical complexity of performing endoscopic retrograde cholangiopancreatography through a previously placed LAMS and underscores the importance of patient-centered care with readiness for adaptability in complex cases.