Post written by Shailendra Singh, MD, and Rohit Agrawal, MD, from West Virginia University, Morgantown, West Virginia, USA.
We present a case series of 6 patients with Roux-en-Y gastric bypass who were referred for management of obstructive symptoms related to gastrojejunal (GJ) anastomosis.
Our patients had failed pneumatic dilations and/or endoscopic stent therapy for severe refractory GJ stenosis with or without angulation of the anastomosis. EUS-guided anastomosis between the gastric pouch and Roux limb was created successfully in all patients, with no major adverse events, resulting in complete resolution of symptoms.
Roux-en-Y gastric bypass is associated with GJ strictures in up to 20% of patients.1,2 Angulation of the anastomosis also can present with obstructive symptoms. A significant proportion of these patients respond to endoscopic therapy such as pneumatic balloon dilations and stent therapy, but with those that remain refractory, surgical revision is the only option that is technically challenging and carries significant morbidity. Our case series highlights the safety and efficacy of this minimally invasive approach of EUS-guided creation of new anastomosis between the gastric pouch and Roux limb as an alternative to surgical revision.
EUS-guided new gastrojejunostomy for management of obstructive symptoms adds to the armamentarium of endoscopic therapies that can be offered to such patients who are poor surgical candidates or want a minimally invasive approach.
Although it is safe and effective, larger prospective studies with longer follow-up are needed to assess long-term outcomes and lasting effects of this intervention. Lastly, better endoscopic techniques that can result in longer patency of anastomosis are needed.
Severe gastrojejunal stricture.
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- Campos GM, Khoraki J, Browning MG, Pessoa BM, Mazzini GS, Wolfe L. Changes in utilization of bariatric surgery in the United States from 1993 to 2016. Ann Surg 2020;271:201-9. ↩︎
- Palermo M, Acquafresca PA, Rogula T, et al. Late surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig 2015;28:139-43. ↩︎
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