Primary anastomosis closure after endoscopic ultrasound-directed transgastric intervention

Author:

Cui YongYan1ORCID,Almario Jose Antonio2,Bejjani Michael3,Khashab Mouen A.3,Irani Shayan4

Affiliation:

1. Gastroenterology, Virginia Mason Medical Center, Seattle, United States

2. Gastroenterology, Johns Hopkins Medicine, Baltimore, United States

3. Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States

4. Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States

Abstract

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.

Publisher

Georg Thieme Verlag KG

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