Abstract
Surgical reversal of Roux-en-Y gastric bypass is associated with significant morbidity. Endoscopic ultrasound (EUS)-guided creation of gastro-gastric (GG) fistulas, using lumen apposing metal stents (LAMS) offers a minimally invasive alternative, but the inability to leave stents in long-term and fistula closure soon after stent removal limits durability.
Consecutive patients underwent parallel-LAMS septotomy for partial reversal of the RYGB between 2023 and 2025 at two tertiary centers. Technical and clinical outcomes were assessed.
Six patients (mean age 64.5 years), mean BMI of 21.9 ± 3.9 kg/m2 underwent parallel-LAMS septotomy. Technical and clinical success was achieved in all 6 patients (100%). All anastomoses were durable on median follow-up of 24 weeks (range 16-50). There were no major adverse events.
Parallel-LAMS septotomy provides a safe and effective endoscopic approach to achieve a durable GG anastomosis, thereby partially reversing RYGB without reliance on in-dwelling stents.