EUS-assisted gastric outlet remodeling in a patient with refractory gastrojejunal anastamotic stricture.

BACKGROUND AND AIMS: Gastrojejunal (GJ) anastomotic strictures occur in up to 30% of patients with Roux-en-Y gastric bypass. The majority of such patients require endoscopic therapy, and many will require revisional surgery after endoscopic therapy fails. We present a novel stepwise approach for definitive endoscopic management of refractory GJ strictures.

METHODS

A 56-year-old female with prior balloon dilatation and lumen-apposing metal stent (LAMS) placement underwent EUS-guided gastric outlet remodeling (EUS-GOR). Two LAMSs were placed in parallel, 1 across the native GJ anastomosis and 1 from the pouch into the afferent limb. After maturation of the intervening tissue tract and prophylactic suturing, a septotomy was performed using wire-guided traction.

RESULTS

The patient tolerated the procedure well and without adverse events. The GJ anastomosis at the end of the procedure measured 20 mm at 3-month follow-up. The patient's body mass index increased from 16.5 to 22.4 kg/m2 at 12 months.

CONCLUSIONS

EUS-GOR is a feasible and minimally invasive option for carefully selected patients with a refractory GJ anastomotic stricture.