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EUS-Guided Endoscopic Gastrointestinal Anastomosis with Lumen-Apposing Metal Stent: Feasibility, Safety, and Efficacy

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Abstract

Traditionally, restoration of normal bowel continuity after resection and bypass of a diseased or obstructed gastrointestinal tract can only be achieved through surgery, which can be technically challenging and comes with a risk of adverse events. Here, we describe our institutions’ experience with endoscopic-guided gastroenterostomy or enteroenterostomy with lumen-apposing metal stent (LAMS) from March 2015 to August 2016. Ten patients had gastrogastrostomy (gastric pouch to gastric remnant) and three patients had jejunogastrostomy (Roux limb to gastric remnant) for the reversal of Roux-en-Y bariatric surgery. One patient had gastroduodenostomy (stomach to duodenal bulb) post antrectomy and one patient had jejunojejunostomy for distal obstruction following Roux-en-Y reconstruction. Technical and clinical success were achieved in all patients, save for delayed anastomotic stenosis following stent removal in one patient, with a mean follow-up of 126 days (3–318 days) with minimal complications in two patients. Endoscopic gastrointestinal anastomosis therefore may be a safe and feasible technique to re-establish continuity of the digestive system following bypass in the short-term.

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Author notes

  1. Stuart K. Amateau and Chin Hong Lim contributed equally to this work.

Authors and Affiliations

  1. Interventional and Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Department of Medicine, University of Minnesota Medical Center, MMC 36-420 Delaware St SE, Minneapolis, MN, 55455, USA

    Stuart K. Amateau & Nicholas M. McDonald

  2. Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA

    Chin Hong Lim, Sayeed Ikramuddin & Daniel B. Leslie

  3. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Mustafa Arain

Authors
  1. Stuart K. Amateau
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  2. Chin Hong Lim
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  3. Nicholas M. McDonald
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  4. Mustafa Arain
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  5. Sayeed Ikramuddin
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  6. Daniel B. Leslie
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Corresponding author

Correspondence to Stuart K. Amateau.

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Conflict of Interest

Dr. Amateau serves as a consultant for Boston Scientific Corporation, the current manufacturer of the lumen-apposing metal stent used in this study. It is the only one currently available in the USA and they have no influence on his scientific endeavors.

Dr. Lim has nothing to disclose.

Dr. McDonald has nothing to disclose.

Dr. Arain received personal fees from Boston Scientific during the conduct of the study.

Dr. Ikramuddin serves as an advisory board member for Novo Nordisk, USGI, and Medica; consults for Medamodix; receives grant support from Medtronic, Enteromedics, and ReShape Medical; and receives consulting income from Enteromedics. The relationship has been reviewed and managed by the University of Minnesota in accordance with its conflict of interest policies.

Dr. Leslie serves as a consultant for Medtronic unrelated to the submitted work.

Ethical Concerns and Informed Consent

Two of the authors are consultants for multiple device companies including Boston Scientific who produce the lumen apposing metal stent utilized in these procedures. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent for the procedure was obtained after a detailed discussion of risks and possible alternatives, including open or laparoscopic surgery. For this type of study, formal consent for data collection is not required.

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Amateau, S.K., Lim, C.H., McDonald, N.M. et al. EUS-Guided Endoscopic Gastrointestinal Anastomosis with Lumen-Apposing Metal Stent: Feasibility, Safety, and Efficacy. OBES SURG 28, 1445–1451 (2018). https://doi.org/10.1007/s11695-018-3171-6

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  • DOI: https://doi.org/10.1007/s11695-018-3171-6

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