Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Abstract

-Introduction -Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. Aim -Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. Methods -The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. Results -The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. Conclusion -Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings. ABCDDV/885RESUMO -Introdução -Bypass gástrico em Y-de-Roux pode resultar em estenose de anastomose gastrojejunal. Não há protocolo de tratamento bem definido para essa complicação. Objetivo -Analisar os resultados da dilatação endoscópica em pacientes com estenose, através de revisão sistemática, incluindo complicações e taxa de sucesso.

Correlation Between Pre and Postoperative Upper Digestive Endoscopy in Patients Who Underwent Roux-en-Y Gastrojejunal Bypass

“…But, the statistical analysis concluded that none of the preoperative factors that were studied had statistic significance to the increase of stenosis in the postoperative period of Roux-en-Y gastrojejunal bypass. This result corroborates with the consensual opinion of the surgeons, that stenosis is a complication which depends much more on the surgical technique than the particular variables of each patient 33 .…”

Complications Related to Gastric Bypass Performed With Different Gastrojejunal Diameters

“…Endoscopic dilation is not without complications, with a rate of 3% 17 . Furthermore, there is no consensus that the procedure, if performed early, is considered safe 18 . Perfuration of the gastrojejunostomy is the main complication, being the most patients conservatively treated 19 .…”

Endoscopy after bariatric surgery

“…Table 1 summarizes the results presented in a large systematic review regarding endoscopic dilatation in patients with stenosis after RYGB [ 32 ]. From 1988 to 2010, 23 studies -the majority of them conducted in the USA- with 760 patients who underwent RYGB (open or laparoscopic) were identified [ 30 , 31 , 33 - 53 ].…”

“…1298 dilatations were performed using TTS balloons in 16 studies (2 of them used additionally Savary-Gillard bougies), while two studies did not report the dilation method and in three studies non-specified balloon types was used. Overall, the success rate of the procedures exceeded 90% (older series excluded), while complications occurred in less than 2% of the patients [ 32 ]. Moreover, in a large cohort of RYGB patients (n=929), successful TTS balloon stricture dilation was related to the early -within 90 days after surgery- occurrence of the stricture since 98% and 61% of the early and late strictures were successfully treated [ 54 ].…”