Post written by Kambiz Kadkhodayan, MD, and Muhammad Hasan, MD, FACG, from the Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, Florida, and Shayan S. Irani, MD, from Virginia Mason Medical Center, Seattle, Washington, USA.

This study introduces a novel technique to partially reverse Roux-en-Y gastric bypass, without the need for an indwelling lumen-apposing metal stent (LAMS). In selected malnourished patients who were poor surgical candidates, we placed 2 adjacent LAMSs to connect the gastric pouch with the excluded stomach. Several weeks later, we removed the stents and divided the intervening tissue septum between the 2 matured tracts, creating a single large anastomosis that restored partial flow of chyme into the excluded stomach and duodenum.

Surgical reversal of gastric bypass can be technically demanding and is associated with significant morbidity, with adverse events in roughly 30% to 58% of patients.¹,² In addition, patients who are most in need of bypass reversal are often the most malnourished and least likely to tolerate an operation. Creating a gastrogastric fistula with a single LAMS is far less invasive, but most of these fistulas close soon after the stent is removed, and prolonged stent dwell time may result in migration, bleeding, and ulceration. There is an urgent clinical need for a durable, stent-free alternative for high-risk patients.

To our knowledge, this is the first multicenter series to show that a durable gastrogastric anastomosis can be created endoscopically without relying on an indwelling stent. All patients in the study achieved technical and clinical success with no major adverse events. Nutritional status improved meaningfully, with a mean albumin increase of 1.4 g/dL and a body mass index increase of 3.5 kg/m² at a median follow-up of 24 weeks.

We believe the durability reflects sustained tissue apposition and remodeling similar to a surgical or device-based anastomoses. The next step is validation in larger prospective studies with longer follow-up to confirm durability and identify which patients will benefit the most.

The technique does require at least 2 separate procedures, involving cost-effectiveness implications and making the procedure less suitable for patients who cannot undergo repeat anesthesia. Moreover, only a portion of the gastric stream is diverted through the newly created gastrogastric conduit, while a substantial proportion of ingested nutrients continues to traverse the Roux limb.

This approach should therefore be regarded as partial reversal of Roux-en-Y bypass. Careful patient selection therefore remains essential. Despite this, for patients requiring bypass reversal who are poor surgical candidates, parallel LAMS septotomy may offer a promising and minimally invasive bridge to patient optimization before surgery or, in selected cases, an alternative to a morbid operation.

Illustration depicting normal Roux-en-Y gastric bypass (RYGB) anatomy (A), step 1 of the parallel lumen-apposing metal stent (LAMS) septotomy procedure for permanent partial reversal of RYGB (B), where 2 LAMSs (red arrows) are placed to connect the gastric pouch with the excluded stomach, 15 to 20 mm apart with an intervening tissue septum. Note the restoration of proximal small-bowel nutrient absorption secondary to partial shunting of chyme into the excluded stomach. In step 2 (C) of the procedure, a septotomy is performed along a plane that connects the epicenter of both mature gastrogastric fistulous tracts (dotted line). This results in the formation of a large, durable fistula between the gastric pouch and the excluded stomach (D).

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1. Plath L, Vannijvel M, Okkema S, et al. Reversal of Roux-en-Y gastric bypass: a multi-centric analysis of indications, techniques, and surgical outcomes. Obes Surg 2025;35:471-80. ↩︎
2. Aeschbacher P, Garcia A, Frieder, J, et al. Outcomes of reversal of malabsorptive and maldigestive bariatric procedures: a single center experience and a systematic review. Surg Obes Relat Dis 2025;21:1025-34. ↩︎