Use of lumen-apposing metal stents in treating gastrojejunal anastomotic strictures in bariatric patients

Abstract

Background: Gastrojejunal strictures (GJS) are rare but significant adverse events following Roux-en-Y Gastric Bypass, with limited options for effective non-operative interventions. Lumen-apposing metal stents (LAMS) represent a new therapy for treatment of intestinal strictures, but the effectiveness in treating GJS is unknown. This study aims to evaluate the safety and effectiveness of LAMS in GJS.

Methods: This is a prospective, observational study of patients with prior Roux-en-Y Gastric bypass who underwent LAMS placement for GJS. The primary outcome of interest is resolution of GJS following LAMS removal defined by toleration of bariatric diet after LAMS removal. Secondary outcomes include need for additional procedures, LAMS-related adverse events, and need for revisional surgery.

Results: Twenty patients were enrolled. The cohort was 85% female with median age of 43. 65% had marginal ulcers associated with the GJS. Presenting symptoms included nausea and vomiting (50% of patients), dysphagia (50%), epigastric pain (20%), and failure to thrive (10%). Diameter of LAMS placed were 15 mm in 15 patients, 20 mm in 3 patients, and 10 mm in 2 patients. LAMS were placed for a median of 58 days (IQR 56-70). Twelve patients (60%) achieved resolution of GJS after LAMS removal. Of the eight patients without GJS resolution or with recurrence, seven (35%) required repeat placement of LAMS. One patient was lost to follow up. One perforation and two migrations occurred. Four patients required revisional surgery after LAMS removal.

Conclusion: LAMS placement is well-tolerated and effective with most patients achieving short-term symptom resolution and with few reported complications. While stricture resolution occurred in over half the patients, nearly 1/4th of patients required revisional surgery. More data is needed to predict who would benefit from LAMS versus surgical intervention.

Keywords: Bariatric surgery; Gastric bypass; Gastrojejunal stricture; Lumen-apposing metal stent.