Endoscopic Ultrasound Guided Gastro-Gastrostomy for Management of Pouch Outlet Obstruction Secondary to Vertical Banded Gastroplasty: Efficacy and Safety

Abstract

Background: Vertical banded gastroplasty (VBG) was one of the preferred bariatric procedures in the 1980s. It includes a vertical staple line to create a small stomach pouch separated from the remainder of the stomach by a dime size hole. Symptoms of pouch outlet obstruction are a common late complication. At our center, we adopted an EUS-guided gastrogastrostomy with a lumen-apposing metal stent to treat this. Methods: We retrospectively analyzed nine consecutive patients who underwent EUS-guided gastrogastrostomy for pouch outlet obstruction (POO) secondary to vertical banded gastroplasty between June 2019 and January 2024. Results: The follow-up period varied with a median period of 5.5 months (IQR 5–21). Patients with obstructive symptoms reported resolution of their symptoms and were able to tolerate a general diet. The median weight change was + 3.1 kg (IQR 1–8.45) with a median relative difference of + 3.7% (IQR 0.84–7.25). No adverse events were encountered, except for late stent migration in two patients. Conclusions: Gastrogastrostomy with LAMS is effective and safe in treating pouch outlet obstruction in patients with a VBG anatomy. However, late stent migration may occur if not removed. Follow-up is required to monitor for fistula persistence after stent removal and to assess weight gain.