Abstract
Background and study aims Endoscopic ultrasound-directed transgastric intervention (EDGI) is a technique that
creates an anastomosis between the gastric pouch or jejunum to the excluded stomach
in Roux-en-Y gastric bypass (RYGB) anatomy to allow access to the pancreaticobiliary
system. Thus far, management of anastomosis closure at the time of lumen-apposing
metal stent (LAMS) removal has varied widely. This study aimed to assess the efficacy
of primary closure at the time of LAMS removal using a through-the-scope (TTS) tack-based
suture system.
Patients and methods This was a two-center retrospective study of RYGB patients who underwent single-stage
EDGI using a 20-mm LAMS and subsequent primary anastomosis closure with the X-tack
system at the time of stent removal. Patient demographics, procedure details, clinical
outcomes, and imaging findings are reported.
Results Nineteen patients (median age 63 years, 84% female) underwent single-stage EDGI with
a median follow-up of 31.5 months. Adverse events occurred in two patients (11%) who
had abdominal pain requiring hospitalization. The median LAMS dwell time was 32 days
(range 16–86). All patients (100%) who underwent follow-up studies after LAMS removal
had confirmed anastomosis closure (n = 18). Most patients had documented weight loss
at the time of LAMS removal and at last follow-up (68%, n = 13).
Conclusions Single-stage EDGI is an effective approach to managing RYGB patients with pancreaticobiliary
pathology. Thus far, endoscopic TTS tack-based suturing appears to have a high success
rate in anastomosis closure after LAMS removal and should be considered as a primary
method for preventing chronic fistulae.
Keywords
Endoscopic ultrasonography - Intervention EUS - Pancreatobiliary (ERCP/PTCD) - Stones
