Endoscopic Balloon Dilation of Gastroenteric Anastomotic Stricture After Laparoscopic Gastric Bypass

Abstract

Stenosis of the gastroenterostomy after laparoscopic gastric bypass occurred in 3.1 % of the patients in this series. It can be successfully and safely treated with endoscopic balloon dilation with good long-term follow-up.

Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

“…Four studies used a linear stapler only 4,18,22,26 and one study used manual suturing only 11 . One study did not describe the type of stapler 1 . Manual suturing resulted in a higher number of dilations compared with using staplers, but a lower average number of dilations per patient ( Table 2).…”

“…Ahmad et al 1 reported that they were able to detect endoscopic evidence of stenosis with localized edema and inflammation around the anastomosis, and proposed dilation in patients with these features even if the patients were asymptomatic. There is no consensus regarding the best way to manage stenosis of the gastrojejunal anastomosis.…”

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

“…Some authors have obtained good results by Savary-Gilliard bougies (11). Although most prefer the use of through-the-scope (TTS) (4,5,8,10,12,(14)(15)(16)(17)(18). Our experience shows that the dilation of the stenosis of the stoma using TTS balloon is safe and effective.…”

“…Published studies are not clear when it comes to describing this aspect. The minority of them clearly manifest not using fluoroscopy during dilation (4,18), others claim to have used it in all or in one of their patients (5,6,8,11,16), and finally, others do not make any sort of comment in this regard in their publications (9,10,14,15,17). Our experience demonstrates that carrying out dilations in patients with stenosis of the anastomosis in the gastric bypass is possible without a fluoroscopic guidance, allowing carrying out the technique in the simplest manner, in the same endoscopy room, without radiation for the patient or for the medical staff, and probably for a shorter period of time.…”

“…This route offers clear advantages compared to open surgery, such as: less blood loss during surgery, less postoperative pain, a lower incidence of wound infections, a shorter hospital stay, and a shorter period of recovery (2). 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.…”