Use of Lumen-Apposing Metal Stents (LAMS) in the Management of Gastro Jejunostomy Stricture Following Roux En Y Gastric Bypass for Obesity.

Background: Chronic strictures following Roux en Y Gastric Bypass (RYGB) are a troublesome complication that can lead to significant morbidity. The use of stents has been described but the need for X-ray and risk of migration have meant limited use in the management of these strictures. Lumen apposing metal stents (LAMS) have traditionally been used for management of pancreatic pseudocysts. They don’t require X-ray and are easy to deploy with a short learning curve. This paper explores the use of LAMS to treat post RYGB strictures and explores their safety and efficacy. Methods: A prospective study over a 4-year period looking at 14 patients with post RYGB strictures. These patients have been followed up for between 1 and 3 years. We have prospectively collected data on the efficacy and safety of LAMS in these patients Results: 421 patients underwent RYGB in the study period. 14 of these patients developed a stricture that resulted in insertion of LAMS. There was no immediate complications and 12 patients had complete resolution of their stricture. There were no migration related issues. Conclusion: LAMS are a safe and effective method to manage post RYGB strictures. They have a high rate of resolution of strictures and can be safely deployed across strictures with no immediate complication. Migration does not appear to be a problem. Insertion is straightforward and doesn’t appear to be associated with a long learning curve.