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Lumen-Apposing Metal Stents for Partial Reversal of Roux-en-Y Gastric Bypass: A Multicenter Study
Journal article   Peer reviewed

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

Kambiz K Kadkhodayan, Azhar Hussain, Saurabh Chandan, Sagar J. Pathak, Mohamad Khaled Almujarkesh, Abdullah Abassi, Artur Viana, Gustavo Bellovincentelli, Mustafa A Arain, Natalie D Cosgrove, …
Gastrointestinal endoscopy, Vol.103(5), pp.957-964
05/2026
DOI: 10.1016/j.gie.2025.10.004
PMID: 41076021

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Abstract

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. 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. 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. 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.

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