Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2018; 10(6): 117-120
Published online Jun 16, 2018. doi: 10.4253/wjge.v10.i6.117
Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture
Muhammad Sohail Mansoor, Juan Tejada, Nour A Parsa, Eric Yoon, Sven Hida
Muhammad Sohail Mansoor, Juan Tejada, Nour A Parsa, Eric Yoon, Sven Hida, Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
Author contributions: Mansoor MS, Tejada J and Yoon E designed the report; Mansoor MS, Parsa NA and Hida S performed the literature review; Mansoor MS, Tejada J and Hida S wrote the manuscript.
Informed consent statement: The patient involved in this study gave informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Muhammad Sohail Mansoor, MD, Academic Fellow, Department of Gastroenterology, Albany Medical Center, 43 New Scotland Ave, 4th Floor A405, Albany, NY 12047, United States. mansoom@amc.edu
Telephone: +1-507-2615816 Fax: +1-518-2626470
Received: January 11, 2018
Peer-review started: January 12, 2018
First decision: March 7, 2018
Revised: March 30, 2018
Accepted: April 19, 2018
Article in press: April 19, 2018
Published online: June 16, 2018
Processing time: 154 Days and 7.8 Hours
Abstract

We are reporting a novel “off-label” use of lumen apposing metal stent (LAMS) for management of refractory gastro-jejunal (GJ) anastomotic stricture after Roux-en-y gastric bypass (RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent (fcSEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient’s symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.

Keywords: Gastro-jejunal anastomotic stricture; Lumen apposing metal stent; Dysphagia; Roux-en-Y gastric bypass

Core tip: Gastro-jejunal (GJ) anastomotic stricture is a common late complication of Roux-en-y gastric bypass. Pneumatic dilation is the first line treatment for these strictures and fully covered self-expanding metal stent (fcSEMS) can be used as an alternative. In this case report we represent the successful off-label placement of lumen apposing metal stent instead of fcSEMS for GJ anastomotic stricture.