Tack-only fixation of lumen-apposing metal stents: leave the suture at home.

Background and Aims: Roux-en-Y gastric bypass (RYGB) may result in refractory gastrojejunal anastomosis (GJA) strictures, which are sometimes treated with lumen-apposing metal stents (LAMSs). To prevent premature stent migration, its fixation may be considered. A tack-and-suture device, designed for through-the-scope mucosal closure, deploys a suture with 4 helical tacks that can also serve in stent fixation. We present a novel tack-only technique for LAMS fixation at the GJA for post-RYGB cases of GJA stenosis. Methods: Four patients who underwent RYGB with GJA stenosis underwent LAMS placement fixated using a tack-only approach. The suture was removed ex vivo, and individual tacks were advanced and drilled through the mesh of the LAMSs' proximal flange at multiple sites to anchor the stent. Results: All 4 LAMSs were successfully fixated without adverse events. The stents remained in place beyond 8.6 weeks. One was removed endoscopically, and 2 were passed spontaneously, with all 3 patients showing resolution of stenosis and symptoms. The fourth patient has been asymptomatic with the stent still in place at 20-week follow-up, with removal planned at 24 weeks. Conclusions: This pilot study suggests the potential feasibility and safety of a tack-only LAMS fixation technique at the GJA. Larger studies are needed to validate this approach.