S2197 Lumen-Apposing Metal Stents for Gastrojejunal Strictures Following Roux-en-Y Gastric Bypass: A Meta-Analysis of Efficacy and Safety

Introduction: Gastrojejunal anastomotic (GJA) strictures are a known late complication following Roux-en-Y gastric bypass (RYGB), often presenting with nausea, vomiting, and intolerance to oral intake. Endoscopic balloon dilation has traditionally been performed to manage GJA strictures but may require multiple sessions and is associated with a risk of recurrence. Lumen-Apposing Metal Stents (LAMS) have emerged as a promising alternative for refractory or recurrent GJ strictures. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LAMS in post-RYGB GJA strictures. Methods: We systematically searched PubMed, Ovid, Google Scholar and Cochrane databases, identifying studies that reported outcomes of LAMS placement post RYGB GJ anastomotic strictures. Outcomes included technical success, short-term and long-term clinical success (defined as symptom resolution lasting ≥3 months after stent removal), reintervention, adverse events, stent migration, and surgical revision. Reintervention was defined as repeat LAMS, balloon dilation, or FCSEMS placement. Surgical revision was defined as operative reconstruction of the GJA. Pooled proportions were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Nine studies with 197 patients with 85.8% women and mean age 52.9 ± 11.1 years with prior failed balloon dilations and refractory GJA stricture were included in the analysis. The pooled clinical success rate of LAMS was 77.1% (95% CI: 59.5-88.5%, I² = 71.2%) while the long-term clinical success was 70.0% (95% CI: 52.7-83.1%). The reintervention rate was 33.5% (95% CI: 23.2-45.6%) and surgical revision occurred in 13.0% (95% CI: 7.8–20.9%) of cases. Migration occurred in 13.1% (95% CI: 7.8%-21.2%), bleeding in 9.3% (95% CI: 4.7%-17.6%), and pain in 9.3% (95% CI: 5.2%-16.1%). Conclusion: LAMS demonstrate a high clinical success rate for the management of refractory GJ strictures after RYGB, though one in 3 patients may require reintervention. These findings support the selective use of LAMS in experienced centers with attention to risk mitigation strategies given notable adverse event rates. Further prospective studies needed to optimize patient selection and minimize risk.