Buttar, Davekaran

ABSTRACT Anastomotic leaks following complex gastrointestinal surgeries pose a significant challenge, especially in patients unfit for further surgical intervention. We present a novel 3-staged endoscopic approach to restore gut continuity in a 55-year-old woman with multiple anastomotic leaks and discontinuous bowel segments following extensive abdominal surgeries. The procedure included stent placement, endoscopic ultrasound (EUS)-guided gastrojejunostomy with a lumen-apposing metal stent (LAMS), and fistula plug insertion with glue. Over 6 months, bowel continuity was restored, and at 6-year follow-up, the patient remains symptom free, tolerating oral intake. This case demonstrates the transformative potential of advanced endoscopic techniques in managing complex gastrointestinal disruptions without further surgery.