Lumen-apposing metal stents for partial reversal of Roux-en-Y gastric bypass: a multicenter study

Abstract

Background and Aims Roux-en-Y gastric bypass (RYGB) is an effective treatment of obesity; however, some patients may develop debilitating postoperative adverse events requiring surgical reversal, which can be technically challenging and highly morbid. Endoscopic ultrasound (EUS)–guided placement of a lumen-apposing metal stent (LAMS) offers a minimally invasive option that creates a gastrogastric fistula. Partial redirection of food into the native stomach results in improvement of nutritional status and may serve either as a bridge to surgery or as definitive therapy. Methods We report a prospective series of 16 patients with adverse events related to RYGB, from 4 tertiary care centers, who underwent EUS-guided LAMS placement and creation of a gastrogastric fistula due to either severe protein-calorie malnutrition, dumping syndrome, or postprandial hyperinsulinemic hypoglycemia. Results Technical and clinical success was achieved in 16 patients (100%) and 15 patients (93.75%), respectively. The median procedure duration was 30 minutes (range, 18-76 minutes). The mean body mass index increased significantly from the time of placement of a LAMS to a mean follow-up of 15.8 months (range, 3-62 months), 21.2 kg/m2 (range, 12.5-33.4 kg/m2) to 24.4 kg/m2 (range, 19.9-32.3 kg/m2) (mean difference: 3.19, P = .002). In addition, there was a statistically significant increase in mean hemoglobin and serum albumin at follow-up. Although there were no procedure-related adverse events, LAMS-related adverse events occurred in 4 patients and included pain, tissue ingrowth, and stent migration. Conclusions EUS-guided LAMS placement is a safe, efficacious, and minimally invasive strategy for partial reversal of RYGB either as a bridge to definitive surgical reversal or as destination therapy.