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

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.