Harsimran Kalsi, MD1, Hassam Ali, MD2, Zaid Ansari, MD3, Rahul Karna, MD4, Sanjeevani Tomar, MD5, Kobina Essilfie-Quaye, MD6, Babu Mohan, MD7, Yaseen Perbtani, DO6, Tony Brar, MD1, Shailendra A. Singh, MD8, Rabindra Watson, MD9, Rashmi Advani, MD10 1University of Central Florida, Gainesville, FL; 2East Carolina University/Brody School of Medicine, Greenville, NC; 3Cleveland Clinic Florida, Weston, FL; 4University of Minnesota Medical Center, Minneapolis, MN; 5AdventHealth, Orlando, FL; 6University of Central Florida, HCA Healthcare GME, Gainesville, FL; 7Orlando Gastroenterology, PA, Orlando, FL; 8West Virginia University School of Medicine, Morgantown, WV; 9Cedars-Sinai Medical Center, Santa Monica, CA; 10Mount Sinai South Nassau,Icahn School of Medicine at Mount Sinai, Oceanside, NY Introduction: Gastrojejunal anastomotic (GJA) strictures are a known late complication following Roux-en-Y gastric bypass (RYGB), often presenting with nausea, vomiting, and intolerance to oral intake. Endoscopic balloon dilation has traditionally been performed to manage GJA strictures but may require multiple sessions and is associated with a risk of recurrence. Lumen-Apposing Metal Stents (LAMS) have emerged as a promising alternative for refractory or recurrent GJ strictures. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LAMS in post-RYGB GJA strictures. Methods: We systematically searched PubMed, Ovid, Google Scholar and Cochrane databases, identifying studies that reported outcomes of LAMS placement post RYGB GJ anastomotic strictures. Outcomes included technical success, short-term and long-term clinical success (defined as symptom resolution lasting ≥3 months after stent removal), reintervention, adverse events, stent migration, and surgical revision. Reintervention was defined as repeat LAMS, balloon dilation, or FCSEMS placement. Surgical revision was defined as operative reconstruction of the GJA. Pooled proportions were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Nine studies with 197 patients with 85.8% females and mean age 52.9± 11.1 years with prior failed balloon dilations and refractory GJA stricture were included in the analysis. The pooled clinical success rate of LAMS was 77.1% (95% CI: 59.5 - 88.5%, I² = 71.2%) while the long-term clinical success was 70.0% (95% CI: 52.7 - 83.1%). The reintervention rate was 33.5% (95% CI: 23.2 - 45.6%) and surgical revision occurred in 13.0% (95% CI: 7.8–20.9%) of cases. Migration occurred in 13.1% (95% CI: 7.8% - 21.2%), bleeding in 9.3% (95% CI: 4.7% - 17.6%), and pain in 9.3% (95% CI: 5.2% - 16.1%). Discussion: LAMS demonstrate a high clinical success rate for the management of refractory GJ strictures after RYGB, though one in three patients may require reintervention. These findings support the selective use of LAMS in experienced centers with attention to risk mitigation strategies given notable adverse event rates. Further prospective studies needed to optimize patient selection and minimize risk.
Figure: Figure -1 Forest Plot of Clinical Success Following LAMS Placement for GJ Anastomotic Stricture After RYGB
Disclosures: Harsimran Kalsi indicated no relevant financial relationships. Hassam Ali indicated no relevant financial relationships. Zaid Ansari indicated no relevant financial relationships. Rahul Karna indicated no relevant financial relationships. Sanjeevani Tomar indicated no relevant financial relationships. Kobina Essilfie-Quaye indicated no relevant financial relationships. Babu Mohan indicated no relevant financial relationships. Yaseen Perbtani indicated no relevant financial relationships. Tony Brar indicated no relevant financial relationships. Shailendra Singh indicated no relevant financial relationships. Rabindra Watson indicated no relevant financial relationships. Rashmi Advani indicated no relevant financial relationships.
Harsimran Kalsi, MD1, Hassam Ali, MD2, Zaid Ansari, MD3, Rahul Karna, MD4, Sanjeevani Tomar, MD5, Kobina Essilfie-Quaye, MD6, Babu Mohan, MD7, Yaseen Perbtani, DO6, Tony Brar, MD1, Shailendra A. Singh, MD8, Rabindra Watson, MD9, Rashmi Advani, MD10. P1403 - Lumen-Apposing Metal Stents for Gastrojejunal Strictures Following Roux-en-Y Gastric Bypass: A Meta-Analysis of Efficacy and Safety, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
