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.
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?
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.
Introduction: Endoscopic metabolic therapies have emerged as less invasive alternatives to bariatric surgery for patients with obesity and poorly controlled type 2 diabetes mellitus (T2DM). The EndoBarrier duodenal-jejunal bypass liner (DJBL) is an endoscopically placed...
Introduction: Endoscopic ultrasound (EUS)-guided transmural drainage is the standard minimally invasive treatment for symptomatic necrotizing pancreatitis. However, the optimal timing of direct endoscopic necrosectomy (DEN) following drainage remains uncertain. While the conventional step-up approach reserves...
Introduction: Bevacizumab is widely used in metastatic colorectal cancer (mCRC) because of its survival benefits but is associated with impaired wound healing, gastrointestinal perforation, and bleeding. These concerns often lead clinicians to delay endoscopic procedures...
Introduction: Endoscopic submucosal dissection (ESD) enables en bloc resection of large colorectal neoplasms with excellent oncological outcomes. However, concerns about perforation have limited its widespread adoption. This large prospective multicenter study evaluated the incidence, risk...
Introduction: Obesity has become one of the greatest global health challenges. New incretin-based therapies—including semaglutide, tirzepatide, resmetirom, and SGLT2 inhibitors such as empagliflozin—have transformed the treatment of obesity, diabetes, and MASLD. However, many patients discontinue...
Introduction: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is the standard technique for diagnosing solid pancreatic lesions. Traditionally, biopsy specimens are processed for cytology, often requiring on-site cytopathology support. This multicenter prospective study evaluated whether directly placing...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.