Fixation of the proximal flange of a lumen-apposing metal stent using a through-the-scope endoscopic suturing system to prevent stent migration in single-session EUS-directed transgastric ERCP: a pilot study

Abstract

With the global obesity pandemic, clinical scenarios requiring urgent ERCP in patients with gastric bypass surgery are on the rise and Single-Session Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (SS-EDGE) can effectively address these technical challenges. The aim of this study was to evaluate and describe safe and effective use of through-the-scope endoscopic suturing system for anchoring the lumen apposing metal stents (LAMS) during SS-EDGE. Six patients with Roux-en-Y gastric bypass (RYGB) underwent SS-EDGE at our center. Through-the-scope endoscopic suturing system was used for anchoring the lumen apposing metal stents (LAMS) during SS-EDGE. Clinical and technical success was achieved in all six patients without any adverse events related to the procedure. No stent migration, pneumoperitoneum or gastrointestinal perforation noted. Upon 4 weeks follow-up, no stent migration was noted with Through-the-scope suturing system remained anchored. LAMS along with tacks were removed and gastric fistulae were successfully closed endoscopically in all patients to prevent weight gain. Use of through-the-scope endoscopic suturing can be a safe, reliable, and potentially cost-effective novel technique for LAMS fixation to successfully perform SS-EDGE in RYGB patients.