56 - Therapeutic Potential of Gastro-Gastric Fistulas Created via Lumen-Apposing Metal Stents for Nutritional Deficiencies in Roux-en-Y Gastric Bypass Patients: A Multicenter Study
Mohamad Khaled Almujarkesh, MD1, Azhar Hussain, MD2, Abdullah Abbasi, MD3, Saurabh Chandan, MD3, Sagar J.. Pathak, MD3, Abdul Sattar Shariq Mohammed, MD1, Gustavo Bellovincentelli, MD1, Natalie Cosgrove, MD3, Mustafa Arain, MD3, Maham Hayat, MD3, Deepanshu Jain, MD3, Artur Viana, MD1, Tareq Alsaleh, MD4, Magda Elamin, MD1, Nihal I. Khan, MD5, Dennis Yang, MD, FACG6, Shayan S. Irani, MD7, Muhammad Hasan, MD, FACG3, Kambiz Khadkhodayan, MD1 1AdventHealth, Orlando, FL; 2SUNY Upstate Medical University Hospital, Syracuse, NY; 3Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, FL; 4Department of Internal Medicine, AdventHealth Orlando, Orlando, FL; 5AdventHealth Orlando, Orlando, FL; 6Center for Interventional Endoscopic, AdventHealth Orlando, Orlando, FL; 7Virginia Mason Medical Center, Seattle, WA Introduction: Roux-en-Y gastric bypass (RYGB) is an effective long-term weight loss operation that improves metabolic diseases. Nutritional deficiencies, however, are highly prevalent despite supplementation, largely due to the exclusion of the proximal small bowel. In RYGB patients that require pancreaticobiliary access, the EUS-directed transgastric ERCP (EDGE) procedure provides a stable gastro-gastric (GG) fistula using a lumen-apposing metal stent (LAMS). The metabolic and nutritional effects of temporary food diversion remain unknown. Methods: We conducted a retrospective review of 60 consecutive RYGB patients from two tertiary centers who underwent EDGE. Nutritional (hemoglobin, vitamins B12, iron, albumin, magnesium, folate, ferritin) and metabolic (weight, BMI, glucose, HbA1c, lipids) parameters were assessed before LAMS placement and after removal. Results: The mean age was 63.2 ± 11.05 years (23% were male). Significant improvements were observed in serum hemoglobin (mean difference (MD) =1.1 g/dL; p=0.004), vitamin B12 levels (MD =204.4 pg/mL; p=0.021), iron (MD=57.9 mcg/dL; p=0.017), albumin (MD=0.4 g/dL; p=0.013), and magnesium levels (MD=0.24 mg/dL; p=0.016). Additionally, serum folate (MD=2.2 μg/mL; p=0.873), and ferritin levels (MD=315.5 μg/mL; p=0.335), showed improvement trends, but these did not reach statistical significance. No significant changes were observed in total body weight, body mass index, serum glucose, hemoglobin A1c, serum triglycerides, LDL, and HDL (p >0.05 for all). Discussion: Temporary partial-reversal of RYGB via LAMS, is associated with significant improvement in key nutritional parameters without adversely affecting the metabolic benefits of RYGB. These findings support a therapeutic role for iatrogenic GG fistulas, as a minimally invasive option for RYGB patients with refractory nutritional deficiencies.
Figure: 1A-1B: Trends of the various nutritional parameters of the study on the multi-line graph over time before and after LAMS placement
2A- 2B: Trends of the various metabolic parameters and total body weight of the study population on the multi-line For Peer Review graph over time before and after LAMS placement
3A,3B,3C: Pearson correlation analysis revealing serum iron levels have strong positive correlation with indwell time of LAMS post-EDGE procedure (r=0.997; p=0.003). (3B) Pearson correlation analysis revealing serum hemoglobin have moderately strong positive correlation with indwell time of LAMS post-EDGE procedure (r=0.55; p=0.045). (3C) Pearson correlation analysis revealing serum vitamin B12 levels have strong positive correlation with indwell time of LAMS post-EDGE procedure (r=0.85; p=0.013)
Figure: Table 1: Summary of various pre- and post-EDGE nutritional and metabolic parameters distribution with mean differences
Disclosures: Mohamad Khaled Almujarkesh indicated no relevant financial relationships. Azhar Hussain indicated no relevant financial relationships. Abdullah Abbasi indicated no relevant financial relationships. Saurabh Chandan indicated no relevant financial relationships. Sagar Pathak indicated no relevant financial relationships. Abdul Sattar Shariq Mohammed indicated no relevant financial relationships. Gustavo Bellovincentelli indicated no relevant financial relationships. Natalie Cosgrove indicated no relevant financial relationships. Mustafa Arain: Boston Scientific – Consultant. Cook Endoscopy – Consultant. Olympus – Consultant. Maham Hayat indicated no relevant financial relationships. Deepanshu Jain indicated no relevant financial relationships. Artur Viana indicated no relevant financial relationships. Tareq Alsaleh indicated no relevant financial relationships. Magda Elamin indicated no relevant financial relationships. Nihal Khan indicated no relevant financial relationships. Dennis Yang: 3D-Matrix – Consultant. Apollo Endosurgery – Consultant. ERBE – Consultant. Fujifilm – Consultant. Medtronic – Consultant. MicroTech – Consultant. Olympus – Consultant. Shayan Irani: Boston Scientific – Consultant. ConMed – Consultant. W.L. Gore – Consultant. Muhammad Hasan: Boston Scientific – Consultant. MicroTech Endoscopy – Consultant. Olympus America – Consultant. Kambiz Khadkhodayan indicated no relevant financial relationships.
Mohamad Khaled Almujarkesh, MD1, Azhar Hussain, MD2, Abdullah Abbasi, MD3, Saurabh Chandan, MD3, Sagar J.. Pathak, MD3, Abdul Sattar Shariq Mohammed, MD1, Gustavo Bellovincentelli, MD1, Natalie Cosgrove, MD3, Mustafa Arain, MD3, Maham Hayat, MD3, Deepanshu Jain, MD3, Artur Viana, MD1, Tareq Alsaleh, MD4, Magda Elamin, MD1, Nihal I. Khan, MD5, Dennis Yang, MD, FACG6, Shayan S. Irani, MD7, Muhammad Hasan, MD, FACG3, Kambiz Khadkhodayan, MD1, 56, Therapeutic Potential of Gastro-Gastric Fistulas Created via Lumen-Apposing Metal Stents for Nutritional Deficiencies in Roux-en-Y Gastric Bypass Patients: A Multicenter Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
