Durable endoscopic gastrojejunal anastomosis using the double-lumen apposing metal stent septotomy technique: Feasibility study

Background and study aims: Surgical gastrojejunostomy (S-GJ) is standard treatment for gastric outlet obstruction (GOO), but is associated with significant morbidity, high cost, and prolonged recovery. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) provides a minimally invasive alternative; however, the anastomosis often closes after removal of the lumen-apposing metal stent (LAMS), limiting its role to palliation. We evaluated feasibility of the double LAMS septotomy technique to achieve durable gastroenterostomy without reliance on indwelling stents. Patients and methods: This was a multicenter pilot-feasibility study in which consecutive adults with GOO underwent EUS-GE with double LAMS septotomy between 2024 and 2025. Step one involved placement of two adjacent LAMS to create parallel gastroenteric fistulas. Step two, performed 3 months later, included stent removal with or without septotomy to consolidate the anastomosis. Technical success, clinical success, adverse events (AEs), and sustained patency of the anastomosis after LAMS removal were assessed prospectively. Results: Six patients (Mean age 70.3 years, 50% benign GOO) underwent the procedure. Technical and clinical success rates were 100%. Four patients completed both steps, with sustained anastomotic patency confirmed endoscopically or radiographically. Among these, spontaneous septum necrosis occurred in two patients (50%) and two patients (50%) required septotomy. Nutritional status improved (mean albumin +0.75 g/dL). There were no major AEs. The patients had no recurrence of symptoms after a mean follow up 26.2 weeks and 17.8 weeks after step one and step two, respectively. Conclusions: The double LAMS septotomy technique is technically feasible, safe, and achieves durable gastrojejunostomy. This strategy may broaden the therapeutic role of EUS-GE in benign disease.