S2343 Lumen-Apposing Metal Stent for Treatment of Gastro-Jejunal Stricture Following Roux-en-Y Gastric Bypass

Abstract

INTRODUCTION: Roux-en-Y Gastric Bypass (RYGB) is the second most common bariatric procedure for weight loss. Gastro-Jejunal (GJ) anastomotic strictures occur in up to 7% of cases. Endoscopic balloon dilation is considered the gold standard for GJ strictures; however, in some cases, it fails to deliver. We present a case in which a refractory GJ anastomotic stricture, after RYGB, was resolved by a novel treatment option. CASE DESCRIPTION/METHODS: A 43-year-old female with an extensive past surgical history including a hiatal hernia repair after Lap-Band and a revision of a sleeve for a kink underwent a laparoscopic sleeve gastrectomy conversion to RYGB for severe reflux. Two days after RYGB, the patient developed dysphagia due to GJ stricture for which she had multiple unsuccessful balloon dilation attempts. It was decided that a lumen-apposing metal stent (LAMS) be used to treat this stricture. The stent was then endoscopically removed in 1 month. Upon removal, the GJ anastomosis appeared patent with healthy-appearing efferent and afferent limbs. The patient now has a patent gastrojejunostomy and can tolerate PO intake. DISCUSSION: GJ anastomotic stricture is a potential complication of RYGB. Serial pneumatic dilation is the traditional endoscopic management. Alternatives include the use of a fully covered self-expanding metal stent (fcSEMS), although a high rate of migration has been reported. LAMS has been increasingly used throughout the gastrointestinal tract; its dumbbell shape design minimizes the risk of migration. This case demonstrates the successful use of LAMS in treating GJ stricture after RYGB.Figure 1.: Gastro-Jejunal anastomotic stricture.Figure 2.: Endoscopic view of Lumen-Apposing Metal Stent.Figure 3.: Resolution of Gastro-Jejunal anastomotic stricture.