Long-term placement of lumen apposing metal stent for EUS guided duodeno and jejuno-jejunal anastomosis for direct access to excluded jejunal limb

Background: Management of biliary disorders in patients with altered anatomy may be challenging. EUS-guided gastrointestinal anastomosis using lumen apposing metal stent (LAMS) have been introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However the appropriate stent indwelling time is still uncertain. We report long-term LAMS deployment after duodeno-jejunal or jejuno-jejunal anastomosis (EUS-DJA) to allow endoscopic re-interventions in case of recurrences. Methods: 11 consecutive patients underwent to EUS-DJA with long standing LAMS between January 2017 and December 2018. ERC treatment was carried out over a 12 months period with multiple endoscopic sessions across DJA. Results: Technical success was 91% (10/11 pts) for EUS-DJA and 100% for ERC. Four patients presented stricture recurrence after an average of 489±31.7 days from the end of ERC treatment. A novel ERC across LAMS anastomosis was feasible in all cases. At average of 781 days±253 all LAMS are still in place with no evidence of any adverse event. Conclusion: Long-term LAMS placement after EUSDJA may be feasible and safe in order to maintain a direct access to the excluded limb.