Agrawal Rohit, Maan Soban, Méndez Alejandra, Haffar Mouaz, Cohen Ethan M, Adekolu Ayowumi A, Krafft Matthew, Thakkar Shyam, Singh Shailendra
Division of Gastroenterology and Hepatology, Department of Medicine, West Virginia University, 5th Floor Health Sciences Center, Suite 5500, PO Box 9161, Morgantown, WV, 26506, USA.
Division of Internal Medicine, West Virginia University, Morgantown, WV, USA.
Dig Dis Sci. 2025 Jan;70(1):316-321. doi: 10.1007/s10620-024-08707-z. Epub 2024 Nov 2.
Roux-en-Y gastric bypass (RYGB) related late gastro-jejunal (GJ) strictures are often resistant to endoscopic balloon dilations. Lumen-apposing metal stents (LAMSs) have been used to treat benign strictures with favorable results. However, the data remains limited to justify LAMS use for management of post-RYGB late GJ strictures. We aim to evaluate the safety and efficacy of LAMS placement for the management of late GJ strictures that are refractory to balloon dilations in post-RYGB patients.
This was a single center retrospective study that included all post-RYGB patients who underwent LAMS placement for management of late GJ strictures that had previously failed balloon dilations. Primary outcomes were technical and clinical success, and secondary outcomes were LAMS-related adverse events.
A total of 28 patients underwent LAMS placement for management of GJ strictures. Median age was 60.5 (IQR 50.5, 67.0) years and majority were females (27, 96.4%). Median interval between surgery and first diagnosis of GJ stricture was 13 years (IQR 7, 17.5). 20 × 10 mm LAMS was the most used stent (n = 24, 85.7%). The median procedure time was 23.5 (IQR 14.5, 32.0) minutes. Technical and short-term clinical success of LAMS placement was 100% (95% CI 87.9-100.0). Long-term success was achieved in 19 out of 25 patients (76.0%, 95% CI 56.6-88.5) that had over 3 months follow-up after LAMS removal. Stent migration was noted in 2 (7.1%) patients, and 1 (3.6%) patient each experienced pain and minor bleeding without the need for additional interventions. No patient in our cohort required surgical revision of GJ anastomosis.
Placement of LAMS is safe, technically feasible, and associated with a high clinical success rate in patients with late GJ strictures after RYGB who have failed prior balloon dilations. Placement of LAMS can be considered early in patients requiring multiple balloon dilations.
Roux-en-Y胃旁路术（RYGB）相关的晚期胃空肠（GJ）狭窄通常对内镜球囊扩张术有抵抗性。管腔贴附金属支架（LAMS）已被用于治疗良性狭窄，效果良好。然而，现有数据仍然有限，不足以证明LAMS可用于治疗RYGB术后晚期GJ狭窄。我们旨在评估LAMS置入术治疗RYGB术后对球囊扩张术难治的晚期GJ狭窄的安全性和有效性。
这是一项单中心回顾性研究，纳入了所有因治疗先前球囊扩张术失败的晚期GJ狭窄而接受LAMS置入术的RYGB术后患者。主要结局是技术成功和临床成功，次要结局是与LAMS相关的不良事件。
共有28例患者接受了LAMS置入术以治疗GJ狭窄。中位年龄为60.5（四分位间距50.5，67.0）岁，大多数为女性（27例，96.4%）。手术与首次诊断GJ狭窄之间的中位间隔时间为13年（四分位间距7，17.5）。20×10 mm的LAMS是最常用的支架（n = 24，85.7%）。中位手术时间为23.5（四分位间距14.5，32.0）分钟。LAMS置入术的技术成功率和短期临床成功率为100%（95%置信区间87.9 - 100.0）。在LAMS取出后有超过3个月随访的25例患者中，19例（76.0%，95%置信区间56.6 - 88.5）获得了长期成功。2例（7.1%）患者出现支架移位，1例（3.6%）患者分别出现疼痛和少量出血，无需额外干预。我们队列中的患者均无需对GJ吻合口进行手术修复。
对于RYGB术后晚期GJ狭窄且先前球囊扩张术失败的患者，LAMS置入术是安全的，技术上可行，且临床成功率高。对于需要多次球囊扩张术的患者，可早期考虑置入LAMS。
