Background

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

Methods

This study retrospectively enrolled patients who underwent LAMS placement for GJS following gastric bypass. Data was collected with manual chart review. Primary outcome of interest was resolution of GJS following LAMS removal. Secondary outcomes included need for additional procedures, LAMS-related adverse events, and need for revisional surgery.

Results

Seventeen patients were enrolled. The cohort was 82% female with median age of 39. The median BMI was 23.6 at time of GJS diagnosis. 59% had marginal ulcers. The most common risk factors for strictures were smoking (50%) and NSAIDs use (25%). LAMS placed were 15 mm in 15 patients and 20 mm and 10 mm, in one patient each. One perforation and one migration occurred. LAMS were placed for 2 months in 9 patients, <2 months in 5, and >2 months in 2 patients. One patient was lost to follow up. Six underwent repeat LAMS placement. 9 patients achieved resolution of GJS after LAMS removal. Four patients required revisional surgery after LAMS removal.

Conclusions

LAMS placement is safe 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.