Durable Endoscopic Partial Reversal of Roux-en-Y Gastric Bypass Using Parallel LAMS Septotomy: GIE | July 2026

Introduction:

Although Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure, a small proportion of patients develop severe nutritional complications, refractory dumping syndrome, or other debilitating adverse events requiring reversal. This study describes a novel endoscopic technique that offers a minimally invasive alternative to surgical reversal.

Why was this technique needed?

Surgical reversal of RYGB carries substantial morbidity, particularly in malnourished or medically complex patients. Conventional EUS-guided gastrogastric fistulas created with lumen-apposing metal stents (LAMS) often close after stent removal, limiting long-term success.

What did the study show?

• Six patients underwent endoscopic partial RYGB reversal using the parallel LAMS septotomy technique.
• Technical and clinical success was achieved in 100% of patients.
• Durable gastrogastric anastomosis was maintained after stent removal in all patients during follow-up.
• No major procedure-related adverse events were reported.
• The technique eliminates the need for permanent indwelling LAMS while maintaining long-term luminal patency.
• Patients experienced sustained restoration of gastric continuity without requiring surgical reversal.

Clinical Impact:

Parallel LAMS septotomy represents an important advance in third-space endoscopy, providing a minimally invasive option for selected patients requiring RYGB reversal. The technique may reduce surgical morbidity while offering durable anatomical restoration.

Take-Home Message:

Parallel LAMS septotomy enables durable endoscopic partial reversal of Roux-en-Y gastric bypass without permanent stent dependence. Although early results are highly encouraging, larger studies with longer follow-up are needed before widespread adoption.