Endoscopic ultrasound-assisted gastric outlet remodeling using parallel lumen-apposing metal stents and septotomy: a...

Gastrojejunal (GJ) anastomotic strictures occur in up to 30% of patients after Roux-en-Y gastric bypass (RYGB). Endoscopic therapies such as balloon dilation and stent placement are generally considered first-line, but a subset of patients remains refractory and requires highly morbid revisional surgery.

We report on consecutive RYGB patients with GJ stenosis with ≥2 failed prior endoscopic therapies, who underwent EUS-assisted gastric outlet remodeling (EUS-GOR).

Twelve patients (mean age 59.08 years [range, 45-85]; 83.3% female) underwent attempted EUS-GOR between 2024 and 2025. Technical success was achieved in 10 of 12 patients (83.3%). Two attempts were aborted due to inability to identify a safe window for lumen-apposing metal stent deployment. Among the technically successful cases (n = 10), clinical success was achieved in 9 patients (90%). Mean Gastric Outlet Obstruction Scoring System improved from 1.3 ± 0.8 pre-procedure to 2.8 ± 1.5 at follow-up (P = .002). Body mass index increased from 24.8 ± 13.3 kg/m² to 25.8 ± 15.8 kg/m² (P = .067), and serum albumin improved from 3.1 ± 1.2 g/dL to 4.1 ± 1.4 g/dL (P = .02) at follow-up. There were no major adverse events. At a mean follow-up of 23.4 weeks (range, 4-63 weeks), 1 patient experienced significant restenosis of the anastomosis. No patients required surgical revision.

EUS-GOR is technically feasible, safe, and clinically effective in patients with refractory GJ strictures post-RYGB. This technique may offer a minimally invasive alternative to surgical revision in high-risk patients.