Tack-only fixation of lumen-apposing metal stents: leave the suture at home

Q3 Medicine

VideoGIE Pub Date : 2025-10-01 DOI:10.1016/j.vgie.2025.05.007

Yara Salameh MD , Hadi K. Abou Zeid MD , Kamal Abi Mosleh MD , Andrew C. Storm MD

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引用次数: 0

Abstract

Background and Aims

Roux-en-Y gastric bypass (RYGB) may result in refractory gastrojejunal anastomosis (GJA) strictures, which are sometimes treated with lumen-apposing metal stents (LAMSs). To prevent premature stent migration, its fixation may be considered. A tack-and-suture device, designed for through-the-scope mucosal closure, deploys a suture with 4 helical tacks that can also serve in stent fixation. We present a novel tack-only technique for LAMS fixation at the GJA for post-RYGB cases of GJA stenosis.

Methods

Four patients who underwent RYGB with GJA stenosis underwent LAMS placement fixated using a tack-only approach. The suture was removed ex vivo, and individual tacks were advanced and drilled through the mesh of the LAMSs’ proximal flange at multiple sites to anchor the stent.

Results

All 4 LAMSs were successfully fixated without adverse events. The stents remained in place beyond 8.6 weeks. One was removed endoscopically, and 2 were passed spontaneously, with all 3 patients showing resolution of stenosis and symptoms. The fourth patient has been asymptomatic with the stent still in place at 20-week follow-up, with removal planned at 24 weeks.

Conclusions

This pilot study suggests the potential feasibility and safety of a tack-only LAMS fixation technique at the GJA. Larger studies are needed to validate this approach.

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单钉固定腔内金属支架：将缝线留在家中

背景和目的roux -en- y胃旁路术（RYGB）可能导致难治性胃空肠吻合（GJA）狭窄，有时使用腔旁金属支架（LAMSs）治疗。为防止支架过早移位，可考虑将其固定。一种钉钉缝合装置，设计用于通过内镜粘膜闭合，采用4个螺旋钉进行缝合，也可用于支架固定。我们提出了一种新颖的单钉技术，用于治疗rygb后GJA狭窄病例的GJA处LAMS固定。方法4例RYGB合并GJA狭窄患者行LAMS置入固定，采用单钉入路。在体外拆除缝线，将单个钉推进并在多个部位钻穿lams近端法兰的网状物以固定支架。结果4例lams均固定成功，无不良反应。支架放置超过8.6周。1例在内镜下切除，2例自发通过，3例患者均显示狭窄和症状消退。第4例患者无症状，在20周的随访中支架仍在，计划在24周移除。结论：本初步研究表明，在GJA采用仅钉固定的LAMS固定技术具有潜在的可行性和安全性。需要更大规模的研究来验证这种方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.