Lumen-Apposing Metal Stents for Partial Reversal of Roux-en-Y Gastric Bypass: A Multicenter Study.

Background and aims: Roux-en-Y gastric bypass (RYGB) is an effective treatment of obesity, however some patients will develop debilitating post-operative complications requiring surgical reversal that can be technically challenging and highly morbid. Endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stent (LAMS) offers a minimally invasive option that creates a gastro-gastric fistula. Partial re-direction 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 complications related to RYGB, from four tertiary care centers, who underwent EUS-guided LAMS placement and creation of a gastro-gastric fistula due to either severe protein-calorie malnutrition, dumping syndrome or postprandial hyper insulinemic 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). Mean body mass index (BMI) increased significantly from the time of placement of LAMS to mean follow up of 15.8 months (range 3-62), 21.2 kg/m² (range 12.5-33.4) to 24.4 kg/m² (range 19.9-32.3), (Mean Difference [MD]: 3.19, P=0.002). Additionally, there was a statistically significant increase in mean hemoglobin (Hb) and serum albumin at follow up. While there were no procedure related adverse events, LAMS related complications occurred in 4 patients and included pain, tissue ingrowth and stent migration.

Conclusion: EUS-guided LAMS placement is a safe, efficacious and minimally invasive strategy for partial reversal of RYGB as either a bridge to definitive surgical reversal or as destination therapy.