Back to 2025 Abstracts
LUMEN-APPOSING METAL STENTS ARE EFFECTIVE AT MANAGING ANASTOMOTIC STRICTURES AFTER ENDOSCOPIC BARIATRIC REVISION THERAPIES
Kimberly F. Schuster
*2, Jonathan Melendez
1, Christopher C. Thompson
11Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Tufts University School of Medicine, Boston, MA
Background: Anastomotic strictures are a frequent complication of endoscopic bariatric and metabolic therapies (EBMT) in patients requiring revisions after bariatric surgery. Endoscopic dilation is commonly pursued; however, this carries a risk of perforation, particularly in patients with anastomotic ulcers. We explored the use of Lumen-Apposing Metal Stents (LAMS) as a novel, safe, and effective alternative.
Methods: We performed a retrospective review of patients with post-EBMT anastomotic stricture who were managed with LAMS placement. Procedural technique, complications, and treatment outcomes were assessed among this cohort. Multivariable regression analysis was utilized to identify factors associated with treatment failure and adverse outcomes.
Results: A total of 194 cases were identified (83% female), with a mean age of 52.5 ± 11.7 years, mean pre-EBMT BMI of 32.4 ± 8.4, and median follow up time of 108 weeks (IQR 35-192 weeks). Most patients previously underwent Roux-en-Y Gastric Bypass (RYGB; n=153, 78.9%) and Laparoscopic Sleeve Gastrectomy (LSG; n=34, 17.5%), with a median interval time from surgery to stenosis of 124 weeks (IQR 37-208 weeks). 173 patients (89.2%) reported obstructive symptoms with 90 patients (46.4%) experiencing poor intake requiring nutritional support. Gastrojejunal anastomosis was the most frequent site of stenosis (GJA; n=142, 74%) followed by distal sleeve (n=31, 16.0%) and proximal sleeve (n=9, 4.6%). 169 patients (87.1%) underwent an average of 2.1 ± 1.6 endoscopic dilations prior to LAMS placement. There was a high rate of successful LAMS placement (94.3%) with 169 (87.1%) patients experiencing symptom improvement and 67.5% tolerating a low residue or regular diet during the follow-up period. There were 29 episodes of stent migration (14.9%) with 18 requiring endoscopic retrieval and 1 causing bowel obstruction. Migration happened in 6/17 (35.9%) of anchored stents compared to 23/177 (12.9%) of those without anchoring. Other adverse events were rare (3.6%), including bleeding and occlusion. There were no perforation events. 74 (38.1%) patients had occurrence of re-stenosis requiring further endoscopic intervention, with 9.2% (n=18) requiring subsequent surgical revision. On regression analysis, smaller stent diameter (p=0.032) and higher number of prior endoscopic treatments (p = 0.047) were predictors of treatment failure, while patients with lower BMI experienced significantly higher rates of stent migration (p=0.041).
Conclusion: LAMS is a safe and effective tool in the management of anastomotic strictures after bariatric procedures with low rates of stent migration and high rates of symptom resolution.
Back to 2025 Abstracts
