Endoscopic ultrasound–assisted gastric outlet remodeling using parallel lumen-apposing metal stents and septotomy: a human feasibility study (with video)

BACKGROUND AND AIMS: Gastrojejunal (GJ) anastomotic strictures occur in up to 30% of patients after Roux-en-Y gastric bypass (RYGB). Endoscopic therapies such as balloon dilation and stent placement are generally considered first-line, but a subset of patients remains refractory and requires highly morbid revisional surgery. METHODS: We report on consecutive RYGB patients with GJ stenosis with ≥2 failed prior endoscopic therapies, who underwent EUS-assisted gastric outlet remodeling (EUS-GOR). RESULTS: (P = .067), and serum albumin improved from 3.1 ± 1.2 g/dL to 4.1 ± 1.4 g/dL (P = .02) at follow-up. There were no major adverse events. At a mean follow-up of 23.4 weeks (range, 4-63 weeks), 1 patient experienced significant restenosis of the anastomosis. No patients required surgical revision. CONCLUSIONS: 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.