Secured Lumen-Apposing Fully Covered Metallic Stents for Stenoses in Post-Bariatric Surgery Patients

Şimşek, Halis; Ichkhanian, Yervant; Fayad, Lea; Steele, Kimberly; Schweitzer, Michael; Lamond, Katherine; Vosoughi, Kia; Doshi, Jay; Shah, Tazkia; Oberbach, Andreas; Al-Sabban, Abdulhameed; Gandsas, Alejandro; Kalloo, Anthony N.; Khashab, Mouen A.; Kumbhari, Vivek

doi:10.1007/s11695-019-03906-4

Cited by 12 publications

(12 citation statements)

References 10 publications

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“…LAMS with endoscopic suture for stricture resolution has been described [ 15 ]. In this series suture of the stent with Overstitch™ was used to anchor the stent.…”

Section: Discussionmentioning

confidence: 99%

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Use of lumen-apposing metal stents (LAMS) in the management of gastro jejunostomy stricture following Roux-en-Y Gastric Bypass for obesity: a prospective series

Skidmore

2021

BMC Surg

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Background Chronic strictures following Roux-en-Y Gastric Bypass (RYGB) are a troublesome complication that can lead to significant morbidity. The use of stents has been described but the need for X-ray and risk of migration have meant limited use in the management of these strictures. Lumen apposing metal stents (LAMS) have traditionally been used for management of pancreatic pseudocysts. They don’t require X-ray and are easy to deploy with a short learning curve. This paper explores the use of LAMS to treat post RYGB strictures and explores their safety and efficacy. Methods A prospective study over a 4-year period looking at 14 patients with post RYGB strictures. These patients were privately insured patients operated within a tertiary Private facility. The patients were followed up for between 1 and 3 years. We have prospectively collected data on the efficacy and safety of LAMS in these patients. Patients were followed up until stent removal or definitive surgery to correct a stricture. Results 421 patients underwent RYGB in the study period. 14 (3.3%) of these patients developed a stricture that resulted in insertion of LAMS. There was no immediate complications and 12 patients had complete resolution of their stricture. There were no reoperations due to migration related issues although a migration rate of 19% was noted. 2 patients required surgery to correct refractory strictures not relieved by a LAMS stent, both of these were strictures associated with marginal ulceration of the gastro jejunostomy. Conclusion LAMS are a safe and effective method to manage post RYGB strictures. They have a high rate of resolution of strictures and can be safely deployed across strictures with no immediate complication. Migration does still appear to be a problem, however, does not appear to affect patient outcome or increase morbidity. Insertion is straightforward and doesn’t appear to be associated with a long learning curve.

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“…LAMS with endoscopic suture for stricture resolution has been described [ 15 ]. In this series suture of the stent with Overstitch™ was used to anchor the stent.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic clips can be unreliable. Overstitch™ fixation of a LAMS as described by Simsek et al [ 15 ] may be an alternative but is technically difficult to use with the LAMS geometry. Once the stricture has resolved SEMS tend to slip through the area and migrate distally.…”

Section: Discussionmentioning

confidence: 99%

Use of lumen-apposing metal stents (LAMS) in the management of gastro jejunostomy stricture following Roux-en-Y Gastric Bypass for obesity: a prospective series

Skidmore

2021

BMC Surg

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“… 4 Although through-the-scope balloon dilation is the initial recommended management in postbariatric strictures, dilatation carries a risk of perforation and high likelihood for recurrence of symptoms, necessitating additional procedures, a drawback that could be overcome by placement of an FCSEMS or LAMS. 12 , 13 Although effective, these therapies carry significant stent migration rates. 4 , 12 To prevent stent migration, stent fixation suturing and over-the-scope clip have been described in the literature but are often challenging, adding procedural time and expense.…”

Section: Discussionmentioning

confidence: 99%

Use of a Lumen-Apposing Metal Stent for Management of Pouch Outlet Stenosis After Vertical Banded Gastroplasty

2021

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Lumen-apposing metal stents (LAMSs) offer a novel alternative for the treatment of anastomotic strictures or short, benign gastrointestinal strictures. In the bariatric realm, LAMSs provide a potentially safer, efficacious, and nonsurgical approach to surgical revision. Here, we present a case where a LAMS was successfully used to manage pouch outlet stenosis from a previous vertical banded gastroplasty.

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“…If the obstruction is at the GJ anastomosis in a patient who has undergone a RYGB, placement of a lumen-apposing metal stent (Boston Scientific, Marlborough, MA) can be performed if the anatomy permits. 19 Large-caliber stents (15-20 mm) are safe to use and will not cause dehiscence of the fresh staple lines.…”

Section: Luminal Obstructionmentioning

confidence: 99%

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

Kumbhari

Cummings

Kalloo³

et al. 2021

Clinical Gastroenterology and Hepatology

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Endoscopic techniques are paramount in the identification and management of complications after surgery, though collaboration with other specialties is obligatory. Unfortunately, the evaluation and treatment algorithms are not standardized and there is a paucity of high-quality prospective studies to provide clarity regarding the best approach. The purpose of this clinical practice update is to apprise the clinician with respect to the endoscopic evaluation and management of patients with early (<90 days) complications after undergoing bariatric/ metabolic surgery. METHODS:The recommendations outlined in this expert review are based on available published evidence, including observational studies and systematic reviews, and incorporates expert opinion where applicable.

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Secured Lumen-Apposing Fully Covered Metallic Stents for Stenoses in Post-Bariatric Surgery Patients

Cited by 12 publications

References 10 publications

Use of lumen-apposing metal stents (LAMS) in the management of gastro jejunostomy stricture following Roux-en-Y Gastric Bypass for obesity: a prospective series

Use of lumen-apposing metal stents (LAMS) in the management of gastro jejunostomy stricture following Roux-en-Y Gastric Bypass for obesity: a prospective series

Use of a Lumen-Apposing Metal Stent for Management of Pouch Outlet Stenosis After Vertical Banded Gastroplasty

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

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