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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(04): E526-E531
DOI: 10.1055/a-2272-0927
Original article

Primary anastomosis closure after endoscopic ultrasound-directed transgastric intervention

YongYan Cui 
1   Gastroenterology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
,
Jose Antonio Almario
2   Gastroenterology, Johns Hopkins Medicine, Baltimore, United States (Ringgold ID: RIN1501)
,
Michael Bejjani
3   Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States (Ringgold ID: RIN1501)
,
Mouen A. Khashab
3   Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States (Ringgold ID: RIN1501)
,
Shayan Irani
4   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
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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


Publication History

Received: 09 November 2023

Accepted after revision: 14 February 2024

Article published online:
15 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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