Treating a refractory gastrojejunal anastomotic stricture

Uchima_headshotHugo Uchima, MD, from the Gastrointestinal Endoscopy Department, Centro Médico Teknon, in Barcelona, Spain shares this video case, “Lumen-apposing metal stent for the treatment of refractory gastrojejunal anastomotic stricture after laparoscopic gastric bypass.”

In this video case we show how a short fibrotic stricture can be treated successfully with a lumen-apposing metal stent.

Our patient is a young female who developed oral intolerance due to a gastrojejunal anastomotic stricture,  one year after laparoscopic  gastric bypass. After 2 attempts of endoscopic balloon dilation (including a perforation during the second dilation that was medically managed), the stricture was the same size and she persisted symptomatic, so finally we decided to use a lumen-apposing metal stent (Axios, Xlumena, Mountain View, California) because its shape fits neatly into a short stricture (like anastomotic ones), and has the adequate lumen diameter for gastric bypass anastomosis, in which a maximum diameter of 12 to 15 mm is desired.

Uchima_fig
Figure 1. X-ray performed 4 weeks after lumen-apposing metal stent (LAMS) placement at the gastrojejunal anastomotic stricture showing correct passage of contrast through the stent.

This case shows that the use of this kind of lumen-apposing metal stents might be a good and safe alternative in the treatment  of gastrojejunal anastomotic stricture.

This lumen-apposing metal stents may be a good alternative for short fibrotic strictures like anastomotic strictures, not only in gastrojejunal anastomotis, but also in esophageal and colonic anastomotic stricture (but using larger diameter devices).

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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