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CC BY-NC-ND 4.0 · Endosc Int Open
DOI: 10.1055/a-2801-5033
Original article

Durable Endoscopic Gastro-Jejunal Anastomosis Using the Double-Lumen Apposing Metal Stent Septotomy Technique. A Feasibility Study

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)

  • Mohamad Khaled Almujarkesh

    3   Gastroenterology, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)

  • Saurabh Chandan

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

  • Abdullah Abassi

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

  • Natalie Cosgrove

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

  • Maham Hayat

    4   Center for Interventional Endoscopy, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)

  • Mustafa A Arain

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

  • Deepanshu Jain

    2   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)

  • Armando Rosales

    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)

  • Muhammad Khalid Hasan

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

  • Shayan Irani

    6   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
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Background: Surgical gastrojejunostomy (S-GJ) is the standard treatment for gastric outlet obstruction (GOO), but is associated with significant morbidity, high cost, and prolonged recovery. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) provides a minimally invasive alternative, however the anastomosis often closes after removal of the lumen-apposing metal stent (LAMS), limiting its role to palliation. We evaluated the feasibility of the double LAMS septotomy technique, to achieve durable gastroenterostomy without reliance on indwelling stents. Methods: This was a multicenter pilot-feasibility study, where consecutive adults with GOO, underwent EUS-GE with double LAMS septotomy between 2024 and 2025. Step-one involved placement of two adjacent LAMS to create parallel gastroenteric fistulas. Step-two, performed three months later, included stent removal with or without septotomy to consolidate the anastomosis. Technical success, clinical success, adverse events and sustained patency of the anastomosis after LAMS removal were assessed prospectively. Results: Six patients (Mean age 70.3 years, 50% benign GOO) underwent the procedure. Technical and clinical success rates were 100%. Four patients completed both steps, with sustained anastomotic patency, confirmed endoscopically or radiographically. Amongst these, spontaneous septum necrosis occurred in 2 patients (50%) and 2 patients (50%) required septotomy. Nutritional status improved (mean albumin +0.75 g/dl). There were no major adverse events. The patients had no recurrence of symptoms after a mean follow up 26.2 weeks and 17.8 weeks after step-one and step-two respectively. Conclusion: The Double LAMS septotomy technique is technically feasible, safe and achieves durable gastrojejunostomy. This strategy may broaden the therapeutic role of EUS-GE in benign disease.



Publication History

Received: 04 September 2025

Accepted after revision: 29 January 2026

Accepted Manuscript online:
29 January 2026

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Bibliographical Record
Kambiz Kadkhodayan, Mohamad Khaled Almujarkesh, Saurabh Chandan, Abdullah Abassi, Natalie Cosgrove, Maham Hayat, Mustafa A Arain, Deepanshu Jain, Sagar Pathak, Armando Rosales, Dennis Yang, Muhammad Khalid Hasan, Shayan Irani. Durable Endoscopic Gastro-Jejunal Anastomosis Using the Double-Lumen Apposing Metal Stent Septotomy Technique. A Feasibility Study. Endosc Int Open ; 0: a28015033.
DOI: 10.1055/a-2801-5033