Open Access
CC BY 4.0 · Endosc Int Open
DOI: 10.1055/a-2713-0016
Original article

Therapeutic Potential of Gastro-Gastric Fistulas Created via Lumen-Apposing Metal Stents for Nutritional Deficiencies after Roux-en-Y Gastric Bypass

Authors

  • Kambiz Kadkhodayan

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
    2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Azhar Hussain

    3   Medicine, Ameer-ud-Din Medical College of PGMI, Lahore, Pakistan (Ringgold ID: RIN473255)
  • Abdullah Abassi

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Saurabh Chandan

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Sagar Pathak

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Gustavo Bello Vincentelli

    4   Bariatric Surgery, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
  • Natalie Cosgrove

    2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Mustafa A Arain

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Maham Hayat

    5   Center for Interventional Endoscopy, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
  • Deepanshu Jain

    2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Artur Viana

    2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Mohamad Khaled Almujarkesh

    6   Gastroenterology, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Tareq Alsaleh

    6   Gastroenterology, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Magda Elamin

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Nihal Ijaz Khan

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Dennis Yang

    1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
  • Shayan Irani

    7   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
  • Muhammad Khalid Hasan

    8   Center for Interventional Endoscopy, Florida Hospital Orlando, Orlando, United States (Ringgold ID: RIN6244)
Preview

Background: Roux-en-Y gastric bypass (RYGB) is an effective long-term weight loss operation with improvements in metabolic diseases. Nutritional deficiencies, however, are highly prevalent despite supplementation, largely due to exclusion of the proximal small bowel. In RYGB patients that require pancreaticobiliary access, the EUS-directed transgastric ERCP (EDGE) procedure provides a stable gastro-gastric (GG) fistula using a lumen-apposing metal stent (LAMS). The metabolic and nutritional effects of temporary food diversion remain unknown. Methods: We conducted a review of 60 consecutive RYGB patients from two tertiary centers, who underwent EDGE. Nutritional and metabolic parameters were assessed before LAMS placement and after removal. Results: Mean age was 63.2 ± 11.05 years, 23% were male. Significant improvements were observed in serum hemoglobin (mean difference (MD) =1.1 g/dL; p=0.004), vitamin B12 levels (MD =204.4 pg/mL; p=0.021), iron (MD=57.9 mcg/dL; p=0.017), albumin (MD=0.4 g/dL; p=0.013), and magnesium levels (MD=0.24 mg/dL; p=0.016). Additionally, serum folate (MD=2.2 μg/mL; p=0.873), and ferritin levels (MD=315.5 μg/mL; p=0.335), showed improvement trends, but these did not reach statistical significance. No significant changes were observed in total body weight, body mass index, serum glucose, hemoglobin A1c, serum triglycerides, LDL and HDL (p>0.05 for all). Conclusion: Temporary partial-reversal of RYGB using a LAMS improves key nutritional parameters without compromising the metabolic benefits of RYGB. These findings may support a therapeutic role for iatrogenic GG fistulas, as a minimally invasive option for RYGB patients with refractory nutritional deficiencies.



Publikationsverlauf

Eingereicht: 09. Juni 2025

Angenommen nach Revision: 22. September 2025

Accepted Manuscript online:
29. September 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Kambiz Kadkhodayan, Azhar Hussain, Abdullah Abassi, Saurabh Chandan, Sagar Pathak, Gustavo Bello Vincentelli, Natalie Cosgrove, Mustafa A Arain, Maham Hayat, Deepanshu Jain, Artur Viana, Mohamad Khaled Almujarkesh, Tareq Alsaleh, Magda Elamin, Nihal Ijaz Khan, Dennis Yang, Shayan Irani, Muhammad Khalid Hasan. Therapeutic Potential of Gastro-Gastric Fistulas Created via Lumen-Apposing Metal Stents for Nutritional Deficiencies after Roux-en-Y Gastric Bypass. Endosc Int Open ; 0: a27130016.
DOI: 10.1055/a-2713-0016