Introduction
Lumen-apposing metal stents (LAMS) have increasingly been used for the management of gastrojejunal anastomotic strictures following Roux-en-Y gastric bypass, although through-the-scope balloon dilation (TTS-BD) remains the first-line therapy.
Aims & Methods
This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of LAMS for gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass using a single-arm meta-analysis. Additionally, we conducted pairwise meta-analyses of studies comparing LAMS and TTS-BD. We systematically searched PubMed, Embase, and the Cochrane Librarydatabases. The primary outcome was clinical success. Secondary outcomes included the need for surgery, overall adverse events, and the most common adverse event. Pooled estimates with 95% confidence intervals (CIs) were calculated for single-arm analyses. For the pairwise meta-analysis of comparative studies, pooled risk ratios (RRs) with 95% CIs were calculated for binary outcomes.
Results
We included nine studies, comprising 189 patients treated with LAMS for gastrojejunal anastomotic strictures following Roux-en-Y gastric bypass. Most patients were female, with the mean age ranging from 43.6 to 62.0 years. The pooled clinical success rate with LAMS was 76.39% (95% CI 61.67–86.67%). The pooled rates for need for surgery and overall adverse events were 15.03% (95% CI 7.46–27.97%) and 18.93% (95% CI 11.21–30.16%), respectively. Stent migration was the most frequently reported adverse event associated with LAMS, occurring in 14.83% of cases (95% CI 7.49–27.25%).Among the included studies, four compared LAMS with TTS-BD, encompassing a total of 200 patients (92 treated with LAMS and 108 with TTS-BD). LAMS was associated with a higher clinical success rate (RR 1.49; 95% CI 1.07–2.07; P=0.02; I2=0%) and a higher risk of overall adverse events (RR 4.31; 95% CI 1.03–17.97; P=0.04; I2=37%) compared to TTS-BD. The need for surgery was similar between groups (RR 0.82; 95% CI 0.05–12.68; P=0.89; I2=88%).
Conclusion
LAMS placement showed to be an effectivetreatment for gastrojejunal anastomotic strictures following Roux-en-Y gastric bypass. However, compared to TTS-BD, LAMS was associated with a higher rate of overall adverse events, most commonly stent migration.
Table 1. LAMS size
| First author, year | Number of patients | LAMS size |
| Agrawal 2025 | 28 | 24: 20 x 10 mm
2: 15 x 15 mm
1: 15 x 10 mm
1: 10 x 10 mm
|
| Hathorn 2020 | 37 | NA |
| Ichkhanian 2022 | 33 | 18: 15 x 10 mm
10: 10 x 10 mm
5: 20 x 10 mm
|
| Jirapynio 2018 | 18 | 9: 10 x 10 mm
7: 15 x 10 mm
|
| Packey 2018 | 17 | 15 x 10 mm |
| Samuels 2023 | 20 | 15: 15 x 10 mm
3: 20 x 10 mm
2: 10 x 10 mm
|
| Sawas 2020 | 11 | NA |
| Shamaa 2024 | 11 | NA |
| Skidmore 2021 | 14 | 15 x 10 mm |
LAMS, Lumen-apposing metal stents; NA, Not Available.
References
1. Agrawal R, et al. Safety and Efficacy of LAMS for Management of Late Refractory Gastro-jejunal Strictures in Patients with Roux-en-Y Gastric Bypass. Dig Dis Sci. 2025.
2. Hathorn K, et al. Gastrojejunal Anastomotic Stenosis: A Matched Cohort Study Comparing Efficacy and Safety of LAMS Placement to Standard Balloon Dilation. Gastrointest Endosc. 2020.
3. Ichkhanian Y. Balloon Dilation vs. Lumen Apposing Metal Stent for the Management of Post RYGB Gastro-jejunal Anastomotic Stricture (GJAS): A Multicenter Comparative Study. Gastrointest Endosc. 2022.
4. Jirapinyo P, et al. Efficacy of LAMS in the Treatment of Gastrojejunal Anastomotic Stenosis. Gastrointest Endosc. 2018.
5. Packey C. Role for LAMS in the Management of Short-Length Gastrointestinal Strictures. Gastrointest Endosc. 2018.
6. Samuels JM, et al. Use of LAMS in Treating Gastrojejunal Anastomotic Strictures in Bariatric Patients. Surg Endosc. 2023.
7. Sawas T. Endoscopic Stenting for Symptomatic Gastrojejunal Anastomotic Stricture Provides Durable Clinical Response After Failed Balloon Dilation. Gastrointest Endosc. 2020.
8. Shamaa O. Management of Gastro-Jejunal Anastomotic Strictures: Comparing Endoscopic Outcomes in Primary vs Conversion Roux-en-Y Gastric Bypass Patients. Am J Gastroenterol. 2024.
9. Skidmore AP. Use of LAMS in the Management of Gastro Jejunostomy Stricture Following Roux-en-Y Gastric Bypass for Obesity: A Prospective Series. BMC Surg. 2021.
