Durable partial reversal of Roux-en-Y gastric bypass using the parallel lumen-apposing metal stent septotomy technique: a multicenter feasibility study (with video)

BACKGROUND AND AIMS: Surgical reversal of Roux-en-Y gastric bypass (RYGB) is associated with significant morbidity. EUS-guided creation of gastrogastric (GG) fistulas, using lumen-apposing metal stents (LAMSs), offers a minimally invasive alternative, but the inability to leave stents in place long term and fistula closure soon after stent removal limit durability. METHODS: Consecutive patients underwent parallel LAMS septotomy for partial reversal of the RYGB between 2023 and 2025 at 2 tertiary centers. Technical and clinical outcomes were assessed. RESULTS: underwent parallel LAMS septotomy. Technical and clinical success was achieved in all 6 patients (100%). All anastomoses were durable at a median follow-up of 24 weeks (range, 16-50). There were no major adverse events. CONCLUSIONS: Parallel LAMS septotomy provides a safe and effective endoscopic approach to achieve a durable GG anastomosis, thereby partially reversing RYGB without reliance on indwelling stents.