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Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass
VideoGIE
Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass
Figure 1. A lumen-opposing metal stent to treat stomal stenosis after Roux-en-Y gastric bypass. A, Ex vivo image of the stent. B, Endoscopic view of the stent deployed across the stricture.
Gastrojejunal stomal strictures occur in 3% to 28% of patients as a late adverse event after Roux-en-Y gastric bypass. They are commonly treated by through-the-scope balloon dilation, although this is associated with a perforation rate of 2% to 5%. Fully covered self-expandable metal stents carry a risk of stent migration, and surgical intervention has a significant morbidity. A 39-year-old woman was referred for management of a stomal stricture 14 years after Roux-en-Y gastric bypass. She had previously undergone 4 sessions of endoscopic balloon dilation without benefit and was eventually started on total parenteral nutrition because she was unable to tolerate fluids. At endoscopy, a tight 2-mm diameter stricture was confirmed. We used a therapeutic gastroscope to deploy a 15-mm lumen-apposing metal stent (Axios; Xlumena, Mountain View, Calif) across the stricture (Fig. 1). The patient was discharged home on a soft diet. She returned after 3 weeks and underwent stent removal with the stricture having successfully
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. www.giejournal.org
increased in size to 10 to 12 mm (Video 1, available online at www.giejournal.org). We demonstrate the novel use of a lumen-opposing metal stent deployed through a therapeutic gastroscope to treat gastrojejunal stomal stenosis after Roux-en-Y gastric bypass. Although success was noted in this case, the optimal duration of stent dwell needs to be determined. DISCLOSURE Dr Khashab is a consultant for Boston Scientific, Xlumena, and Olympus America and has received research support from Cook Medical. Dr Singh is a consultant for Santarus, D-Pharm, Abbvie, and Boston Scientific. All other authors disclosed no financial relationships relevant to this publication. Vivek Kumbhari, MD, Alan H. Tieu, MD, Saowanee Ngamruengphong, MD, Gerard Aguila, BSN, Departments of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Michael A. Schweitzer, MD, Department of Surgery, The Johns Hopkins Medical Institutions, Mouen A. Khashab, MD, Vikesh K. Singh, MD, Departments of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2015.05.032
Volume 82, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 747
Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass
Figure 1. A lumen-opposing metal stent to treat stomal stenosis after Roux-en-Y gastric bypass. A, Ex vivo image of the stent. B, Endoscopic view of the stent deployed across the stricture.
Gastrojejunal stomal strictures occur in 3% to 28% of patients as a late adverse event after Roux-en-Y gastric bypass. They are commonly treated by through-the-scope balloon dilation, although this is associated with a perforation rate of 2% to 5%. Fully covered self-expandable metal stents carry a risk of stent migration, and surgical intervention has a significant morbidity. A 39-year-old woman was referred for management of a stomal stricture 14 years after Roux-en-Y gastric bypass. She had previously undergone 4 sessions of endoscopic balloon dilation without benefit and was eventually started on total parenteral nutrition because she was unable to tolerate fluids. At endoscopy, a tight 2-mm diameter stricture was confirmed. We used a therapeutic gastroscope to deploy a 15-mm lumen-apposing metal stent (Axios; Xlumena, Mountain View, Calif) across the stricture (Fig. 1). The patient was discharged home on a soft diet. She returned after 3 weeks and underwent stent removal with the stricture having successfully
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. www.giejournal.org
increased in size to 10 to 12 mm (Video 1, available online at www.giejournal.org). We demonstrate the novel use of a lumen-opposing metal stent deployed through a therapeutic gastroscope to treat gastrojejunal stomal stenosis after Roux-en-Y gastric bypass. Although success was noted in this case, the optimal duration of stent dwell needs to be determined. DISCLOSURE Dr Khashab is a consultant for Boston Scientific, Xlumena, and Olympus America and has received research support from Cook Medical. Dr Singh is a consultant for Santarus, D-Pharm, Abbvie, and Boston Scientific. All other authors disclosed no financial relationships relevant to this publication. Vivek Kumbhari, MD, Alan H. Tieu, MD, Saowanee Ngamruengphong, MD, Gerard Aguila, BSN, Departments of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Michael A. Schweitzer, MD, Department of Surgery, The Johns Hopkins Medical Institutions, Mouen A. Khashab, MD, Vikesh K. Singh, MD, Departments of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2015.05.032
Volume 82, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 747