Concurrent stricturoplasty with lumen-apposing metal stents for gastrojejunal strictures after Roux-en-Y gastric bypass

Abstract Background Gastrojejunal (GJ) anastomotic strictures are a challenging complication following Roux-en-Y gastric bypass (RYGB) and may be refractory to conventional balloon dilation. Lumen-apposing metal stents (LAMS) provide anchored, wide-caliber support that may treat strictures, yet long-term outcomes remain variable, and stent migration is a concern. This study evaluates the clinical effectiveness and safety of LAMS with or without concurrent endoscopic stricturoplasty in patients with GJ strictures. Methods We conducted a single-center retrospective cohort study of patients with GJ strictures who underwent LAMS placement between January 2020 and May 2025. Patients were stratified by whether concurrent endoscopic stricturoplasty was performed at the time of stent placement. Clinical success was defined as symptom resolution without need for reintervention. The primary outcome was long-term clinical success (> 90 days). Secondary outcomes included short-term clinical success (≤ 30 days), stent dwell time, procedure duration, stent migration, and adverse events. Results Twenty-five patients were included (mean age 46.8 ± 12.9 years; 76% female), with 7 (28%) undergoing concurrent stricturoplasty. The overall cohort short-term and long-term clinical success rates were 88.0% and 64.0% respectively. Long-term success was 71.4% in the stricturoplasty group vs. 61.1% in the LAMS-only group (p = 0.985). Stent migration occurred in 3 patients (12.0%), all in the LAMS-only group (0% vs. 16.7%, p = 0.641). Mean stent dwell time was shorter in the stricturoplasty group (52.6 vs. 90.4 days, p = 0.896), and the stricturoplasty group had significantly higher rates of prior ≥ 3 balloon dilations (85.7% vs. 16.7%, p = 0.006), suggesting a more refractory phenotype. Conclusions LAMS is a safe and effective treatment for GJ strictures after RYGB, with high short-term success. In patients with multiple prior dilations or complex fibrotic strictures, concurrent stricturoplasty appears to be a technically feasible adjunct that may reduce stent migration and improve durability. These trends support further investigation.