Endoscopic ultrasound-assisted double-lumen-apposing metal stent septotomy for permanent partial reversal of...

Surgical reversal of Roux-en-Y gastric bypass (RYGB) is associated with high morbidity but may be necessary in patients with malnutrition. In recent years, endoscopic gastrogastric (GG) fistulas created via lumen-apposing metal stents (LAMSs) have offered patients a less-invasive alternative, but they are associated with adverse events if left in situ for long periods of time. We describe the use of a double-LAMS septotomy technique with septotomy to achieve permanent and durable partial RYGB reversal.

A 39-year-old man with severe malnutrition (body mass index [BMI] 18.4 kg/m²) underwent an EUS-guided placement of 2 parallel GG LAMSs. Six weeks later, both LAMSs were removed, and the septum between the 2 GG fistulas was dissected using an insulated-tip knife.

There were no intraprocedural or postprocedural adverse events. The patient was discharged on a liquid diet and transitioned to a regular solid diet. He maintained weight gain (BMI 28 kg/m²) on clinical follow-up.

EUS-guided double-LAMS septotomy is safe, minimally invasive, and durable for partial permanent reversal of RYGB in high-risk patients.