Tack-only fixation of lumen-apposing metal stents: leave the suture at home.

Abstract

<h4>Background and aims</h4>Roux-en-Y gastric bypass (RYGB) may result in refractory gastrojejunal anastomosis (GJA) strictures, which are sometimes treated with lumen-apposing metal stents (LAMSs). To prevent premature stent migration, its fixation may be considered. A tack-and-suture device, designed for through-the-scope mucosal closure, deploys a suture with 4 helical tacks that can also serve in stent fixation. We present a novel tack-only technique for LAMS fixation at the GJA for post-RYGB cases of GJA stenosis.<h4>Methods</h4>Four patients who underwent RYGB with GJA stenosis underwent LAMS placement fixated using a tack-only approach. The suture was removed ex vivo, and individual tacks were advanced and drilled through the mesh of the LAMSs' proximal flange at multiple sites to anchor the stent.<h4>Results</h4>All 4 LAMSs were successfully fixated without adverse events. The stents remained in place beyond 8.6 weeks. One was removed endoscopically, and 2 were passed spontaneously, with all 3 patients showing resolution of stenosis and symptoms. The fourth patient has been asymptomatic with the stent still in place at 20-week follow-up, with removal planned at 24 weeks.<h4>Conclusions</h4>This pilot study suggests the potential feasibility and safety of a tack-only LAMS fixation technique at the GJA. Larger studies are needed to validate this approach.