Lumen Apposing Metal Stents for Gastrojejunal Anastomotic Stricture Following Metabolic Bariatric Surgery

The standard of care for gastrojejunal anastomotic stricture following metabolic bariatric bypass surgery is endoscopic balloon dilatation, with revisional surgery as a last line option. The use of lumen-apposing metal stents is expanding to include many gastrointestinal benign and malignant causes in selected cases. They may provide an additional treatment option for post-bypass strictures.

A single centre, retrospective outcomes analysis was performed over a 3-year period of patients with gastrojejunal anastomotic stricture following metabolic bariatric surgery that was treated with a lumen-apposing metal stent. Primary outcomes assessed were clinical success and perforation. Multiple secondary outcomes were assessed regarding safety and endoscopy use.

Of 88 patients that had lumen-apposing metal stents placed, 20 satisfied selection criteria. Eleven patients (55%) had at least one balloon dilatation prior to stent placement. All patients achieved clinical success 20 (100%) with zero perforations. Technical success was achieved in 19 patients (95%). There were four (20%) recurrent strictures, two stent migrations (10%) (with no associated complication), and one in-stent food bolus obstruction (5%). One patient ultimately required surgical revision (5%). Three patients had endoscopy within 30 days of stent removal (15%), and five patients required unplanned endoscopy with the stent in situ (25%).

Lumen-apposing metal stents within our study show potential as another treatment option for gastrojejunal anastomotic stricture following gastric bypass.