Supplementary Material for: Delayed jejunal perforation after endoscopic ultrasound-guided gastroenterostomy: a case report and literature review

Introduction: Endoscopic ultrasound-guided gastroenterostomy is an emerging treatment for malignant gastric outlet obstruction, with high clinical and technical success rates and reported complication risks around 10%. However, the long-term risks associated with the presence of a metal stent remain unclear. Case presentation: We present the case of a 35-year-old male with duodenal carcinoma and peritoneal metastases, treated with endoscopic ultrasound-guided gastroenterostomy because of gastric outlet obstruction, who developed a delayed jejunal perforation ten months after the procedure. The perforation, likely related to the lumen-apposing metal stent, was resected. Thereafter, the patient recovered and resumed immunotherapy with no measurable disease on follow-up computed tomography. Conclusion: This report describes a case with a delayed jejunal perforation ten months after endoscopic ultrasound-guided gastroenterostomy in a patient with metastatic duodenal carcinoma with complete treatment response to immunotherapy. We advise stent removal once the duodenal obstruction has resolved, given the potential risk of complications associated with prolonged stents in place.