Management of Gastro-Jejunal Anastomotic Strictures: Comparing Endoscopic Outcomes in Primary vs Conversion Roux-en-Y Gastric Bypass Patients

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Conversion surgery from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) is a common intervention for GERD and weight recurrence. There is limited data on post-surgical gastrojejunal anastomotic strictures (GJAS) endoscopic therapy outcomes in patients with sleeve gastrectomy to Roux-en-Y gastric bypass (SG-RYGB) conversion surgeries. Our study aims to compare the outcomes of primary RYGB (P-RYGB) and SG-RYGB GJAS when treated with through-the-scope balloon dilation (TTS BD) and lumen-apposing metal stent (LAMS). Methods: This is a single center retrospective study, that included patients diagnosed with GJAS post P-RYGB and SG-RYGB surgeries who underwent TTS BD or intraluminal LAMS placement. Data was collected between 2/1/2013 - 1/1/2023. Primary outcomes were technical success, clinical success, surgical revision & mortality. Secondary outcomes included immediate clinical success and the number of endoscopic sessions needed to achieve clinical success. Results: A total of 22 patients were identified to have GJAS, 13 post P-RYGB (age 55 67) & 9 post SG-RYGB (age 45.5 66). Among the P-RYGB group, 4 patients were treated with TTS BD (median stricture diameter 5 mm) and 9 with LAMS (median stricture diameter 5.5 mm). Whereas within the 9 SG-RYGB patients, 7 received TTS BD (median stricture diameter 8.5 mm), and 2 underwent LAMS placement (median stricture diameter 7 mm). All 22 patients had a 100% technical success rate with no mortality or need for surgical revision. Half (n=2/4) of the P-RYGB patients had clinical success with TTS BD compared to 89% (n=8/9) of those who received LAMS. In SG-RYGB patients, almost half of those who received TTS BD (n=3/7) & LAMS stents (n=1/2) had immediate clinical success following first intervention. During the duration of the study, 4/7 (57%) TTS BD and 2/2 (100%) LAMS SG-RYGB patients maintained clinical success without symptom recurrence. One P-RYGB case experienced intraprocedural LAMS mis-deployment. Post-procedure adverse event rates were reported in 1 P-RYGB TTS BD patient & 3 P-RYGB LAMS patients (Table 1). Conclusion: This study demonstrates that both TTS BD and LAMS are effective in the management of GJAS following primary as well as conversion bariatric surgery. LAMS generally exhibited higher immediate and maintenance clinical success rates compared to TTS BD, especially in P-RYGB patients. Further multicenter research involving larger patient cohorts is warranted to optimize patient outcomes in this population. (Table Presented).

Volume

119

Issue

10

First Page

S1118

Last Page

S1119

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