Abstract
Gastro-jejunal (GJ) anastomotic strictures occur in up to 30 % of patients after Roux-en-Y gastric bypass (RYGB). Endoscopic therapies such as balloon dilatation and stent placement are generally considered first-line, but a subset of patients remain refractory and require highly morbid revisional surgery.
We report on consecutive RYGB patients with GJ stenosis with ≥2 failed prior endoscopic therapies, who underwent Endoscopic ultrasound-assisted gastric outlet remodeling (EUS-GOR).
Twelve patients [mean age 59.08 years (range=45-85), 83.3% female] underwent attempted EUS-GOR between 2024 and 2025. Technical success was achieved in 10 of 12 patients (83.3%). Two attempts were aborted due to inability to identify a safe window for LAMS deployment. Amongst the technically successful cases (n=10), clinical success was achieved in 9 patients (90%). Mean GOOSS improved from 1.3 ± 0.8 pre-procedure to 2.8 ± 1.5 at follow-up (p=0.002). BMI increased from 24.8 ± 13.3 kg/m2 to 25.8 ± 15.8 kg/m2 (p=0.067), and serum albumin improved from 3.1 ± 1.2 g/dl to 4.1 ± 1.4 g/dl (p=0.02) at follow up. There were no major adverse events. At mean follow up of 23.4 weeks (range= 4- 63 weeks), one patient experienced significant re-stenosis of the anastomosis. No patients required surgical revision.
EUS-GOR is technically feasible, safe and clinically effective in patients with refractory GJ strictures post-RYGB. This technique may offer a minimally invasive alternative to surgical revision in high-risk patients.