EUS-directed transgastric access to the excluded stomach to facilitate pancreaticobiliary interventions in patients with Roux-en-Y gastric bypass anatomy

EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience

“…In our cohort, all cases of LAMS migration occurred in patients where no anchoring of the LAMS was performed (p=0.001), supporting the existing evidence on EDGE of LAMS anchoring being a protective factor against LAMS migration 16,28 . Literature is conflicted with regards to the association between LAMS migration and SS-EDGE, with some reporting a higher risk during SS-EDGE as compared to DS-EDGE, while others proposing that SS-EDGE can be safely performed if anchoring of the LAMS is performed 27,29 .…”

“…LAMS migration is most feared when occurring soon after transgastric access creation, as the fistula is still immature, and migration can result in serious complications such as perforation or peritonitis 16 . Nevertheless, in most cases, LAMS migration can be managed endoscopically without ill consequences 13,16,26,28 . In our cohort, only one patient with LAMS migration required surgical intervention, while all other cases were managed endoscopically and rated as mild/moderate.…”

“…In our cohort, even though higher rates of LAMS migration were seen in SS-EDGI as compared to DS-EDGI, this was not statistically significant. The use of a larger LAMS diameter was also reported to be protective against LAMS migration in SS-EDGE, possibly due to lower friction when passing the endoscope 13,28,27 . In our study, LAMS migration was more frequent among patients with a 15-mm LAMS as opposed to those with a 20-mm LAMS where only one LAMS migration event occurred.…”