Novel Lumen-Apposing Metal Stent for Treatment of a Benign Refractory Stricture from Prior Vertical Banded Gastroplasty

Abstract

A 67 year old male with prior vertical banded gastroplasty (VBG) presented with recurrent dysphagia due to development of a gastrogastric narrowing at the distal end of the gastric pouch. The narrowing and related symptoms continued to persist despite multiple trials of endoscopic balloon dilatation (EBD). The patient then underwent needle knife stricturoplasty followed by placement of a 14 mm x 10 mm esophageal stent (Alimaxx-ESTM; Merit Medical Endotek, South Jordan, Utah, USA) under endoscopic and fluoroscopic guidance to prevent the complication of bleeding. Three weeks after stricturoplasty and stent placement, the stent was removed, and it was noted that the gastric band from prior VBG had eroded through the area and remained intact in its circular orientation. This band was successfully removed with rat tooth forceps. Five weeks after removal of the gastric band, a stricture 2 mm in diameter was found at the gastrogastric anastomosis. The decision was made to use a lumen-apposing self-expandable metal stent (LAMS) for treatment of the stricture. A through-the-scope (TTS) balloon was utilized for dilation of the stricture to 8 mm. Under endoscopic and fluoroscopic guidance, a 10 mm x 10 mm LAMS (AXIOSTM Stent, Boston Scientific, Marlborough, Massachusetts, USA) was placed across the stricture with good position. At 11-week follow-up, patient was asymptomatic, and the stented area was fully patent with no evidence of migration, erosion or restenosis. At 22 weeks patient continues to do clinically well without dysphagia. Given his clinical improvement and condition of the stent, the decision was made to have the stent remain with serial endoscopic surveillance. The use of LAMS for treatment of refractory benign strictures may serve as a safe and definitive alternative treatment to EBD. Furthermore, the risk of migration, which has been associated with use of traditional fully-covered self-expanding metal stents, is potentially lower with LAMS. Further long term outcome studies with these stents used in benign strictures are warranted.Figure 1Figure 2