Endoscopic anastomotic reconstruction with lumen-apposing metal stents

This case is a presentation on the use of lumen-apposing metal stents (LAMSs) and then endoscopic dissection to permanently re-establish continuity between the gastric pouch and remnant in a complex and hostile abdomen.

A 56-year-old man with a previous Roux-en-Y gastric bypass, performed for weight loss, developed life-threatening gastric injury, including perforation after chronic consumption of nonsteroidal anti-inflammatory drugs. He underwent multiple operations, finally resulting in a gastrostomy, and his gastric remnant and pouch were closed. Subsequently, he was reliant solely on parenteral feeding. After multidisciplinary discussion, a 3-step endoscopic procedure was used to reconnect the gastric pouch and remnant. In the first 2 steps, LAMSs were used to create a fistula and establish a connection between the pouch and remnant, facilitating a liquid diet. Endoscopic dissection was later undertaken to dissect the bridge between the 2 stents, which were subsequently removed, and endoscopic suturing was used to ensure the connection between the previously divided stomach.

There were no significant immediate or delayed adverse events of the procedure. The patient is now able to tolerate both a liquid and soft diet.

This case demonstrates the novel and successful endoscopic management to permanently reverse a Roux-en-Y gastric bypass as a result of adverse events.