ERCP in patient with Roux-en-Y gastric bypass and high grade duodenal stricture across dual lumen-apposing metal stents

Enteral stents are tubular devices that can reestablish the patency of the gastrointestinal (GI) lumen in the setting of high-grade obstruction. Although they have been more commonly used in the palliation of malignant obstruction, they now have expanding roles for benign luminal strictures and stenoses. Familiarity with the indications and contraindications for enteral stent placement can enable consideration of a less invasive and morbid therapeutic option for many patients with symptomatic obstructions. The development of self-expandable metal stents and the subsequent emergence of lumen-apposing coaxial metal stents have expanded the role of enteral stents in the management of various GI disorders. This review contains 49 references, 5 figures, and 5 tables. Key Words: coaxial, enteral, gastrointestinal malignancy, lumen-apposing, obstruction, palliation, stent

Download Full-text

Invited Commentary to "Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery" (Eur Surg 38/6: 451–455, 2006)

European Surgery ◽

10.1007/s10353-006-0307-z ◽

2007 ◽

Vol 39 (1) ◽

pp. 67-68

Author(s):

H. G. Weiss

Keyword(s):

Gastric Bypass ◽

Gastric Outlet Obstruction ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Outlet Obstruction ◽

Metal Stents ◽

Malignant Gastric Outlet Obstruction ◽

Self Expanding Metal Stents ◽

Endoscopic Implantation

Download Full-text

Novel approach to therapeutic ERCP after long-limb Roux-en-Y gastric bypass surgery using transgastric self-expandable metal stents: experimental outcomes and first human case study (with videos)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.02.026 ◽

2012 ◽

Vol 75 (6) ◽

pp. 1258-1263 ◽

Cited By ~ 16

Author(s):

Todd H. Baron ◽

Louis M. Wong Kee Song ◽

Lincoln E.V.V. Ferreira ◽

Thomas C. Smyrk

Keyword(s):

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Human Case ◽

Metal Stents ◽

Novel Approach ◽

Therapeutic Ercp

Download Full-text

Use of Lumen-Apposing Metal Stents (LAMS) in the Management of Gastro Jejunostomy Stricture Following Roux En Y Gastric Bypass for Obesity.

10.21203/rs.3.rs-429795/v1 ◽

2021 ◽

Author(s):

Adam Peter Skidmore

Keyword(s):

Gastric Bypass ◽

Learning Curve ◽

Complete Resolution ◽

High Rate ◽

Pancreatic Pseudocysts ◽

Metal Stents ◽

Efficacy And Safety ◽

X Ray ◽

Short Learning Curve ◽

A Prospective Study

Abstract 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.MethodsA prospective study over a 4-year period looking at 14 patients with post RYGB strictures. These patients have been followed up for between 1 and 3 years. We have prospectively collected data on the efficacy and safety of LAMS in these patientsResults421 patients underwent RYGB in the study period. 14 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 migration related issues.ConclusionLAMS 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 not appear to be a problem. Insertion is straightforward and doesn’t appear to be associated with a long learning curve.

Download Full-text