Endoscopic Balloon Dilation of Anastomotic Strictures Occurring after Laparoscopic Gastric Bypass for Morbid Obesity

Abstract

Background: Gastrojejunal anastomotic stenosis of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity occurs in 3–25% of cases. The aim of this report was to evaluate the utility of endoscopic balloon dilation for the therapy of anastomotic strictures after LRYGB. Patients and Methods: 111 consecutive patients were treated with endoscopic dilation under sedation with propofol. Dilations were performed with through-the-scope over-the-wire balloons, with sizes ranging from 6 to 18 mm. The outcomes of the procedure were analyzed. Results: 200 endoscopic balloon dilations were performed in 111 patients. Repeated dilations were necessary in patients with complex stenosis. In 75% of the patients it was possible to dilate to 12 mm during the first session. Only in 2% of the cases was it impossible to introduce the endoscope through the stenosed anastomosis after dilation. On follow-up a repeat dilation was necessary in 26% of the cases. Minor complications occurred in 2.7% of patients (2 concealed perforations and 1 hematoma of the esophagus). These were treated conservatively. None of the patients required operation. Conclusions: Endoscopic balloon dilation is a safe and effective therapy for anastomotic strictures occurring after LRYGB.

Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

“…A total of 1,298 dilations were performed in the 760 patients included in the review, which was an average of 1.7 dilations per patient. This was consistent with the data reported by Caro et al 6 , who reported 1.8 dilations per patients. The studies indicated that this complication of surgery could be resolved with a small number of dilation procedures, with endoscopy being the best treatment choice.…”

“…One (8%) left the balloon inflated until the waist disappeared, followed by another dilation lasting 30-60 s 19 . Seven studies reported complications 6,11,17,20,23,26,29 (T able 4). Perforation was the most common complication, reported in 14 patients (1.82%) and requiring immediate operation in two patients 26 .…”

“…Perforation was the most common complication, reported in 14 patients (1.82%) and requiring immediate operation in two patients 26 . Complications were reported in five other patients: one esophageal hematoma 6 , one Mallory-Weiss tear (it was not clear if this was iatrogenic or was present before starting the procedure) 20 , one developed severe nausea and vomiting 23 , and two developed severe abdominal pain 29 …”

The role of upper gastrointestinal endoscopy in treating postoperative complications in bariatric surgery

“…Caro et al reviewed 111 patients that had undergone endoscopic balloon dilatation following RYGB 50 and reported two perforations and one hematoma of the esophagus following a total of 200 endoscopic dilatations. An average of 2.2 endoscopic dilatations per patient were needed to treat gastrojejunal strictures post-RYGB.…”

Stenosis in laparoscopic gastric bypass: management by endoscopic dilation without fluoroscopic guidance

“…The stenosis of the stoma (stenosis of the gastro-jejunal anastomosis) occurs in approximately 3-12% after gastric bypass, and must be suspected when the patient experiences dysphagia, nausea and vomiting (2)(3)(4)(5)(6)(7)(8)(9). Endoscopic dilation of the stenosis by means of a balloon or bougie is considered the treatment of choice, even if in most studies it is not quite clear whether it should be done with or without a radioscopic guidance (4)(5)(6)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) In this study, we informed of our experience in the management of the stenosis of the stoma in patients with laparoscopic gastric bypass by means of endoscopic dilation with a hydrostatic balloon, without fluoroscopic guidance.…”