Is pneumatic balloon dilation safe and effective primary modality of treatment for post-sleeve gastrectomy strictures? A retrospective study

Abstract

BackgroundThe optimal treatment of sleeve strictures has not been agreed upon at the current time. At our institution, we began using pneumatic balloon dilation to help resolve these obstructions in 2010. Herein we report our experience with pneumatic balloon dilation for the treatment of sleeve strictures.MethodsFrom Jan 2010 to Dec 2016 we retrospectively reviewed our prospectively kept database for patients who developed a Laparoscopic Sleeve Gastrectomy (LSG) stricture within 90 days of surgery. If the stricture was found, then we dilated all our patients initially at 30 mm at 10 PSI for 10-20 min (14.5 min average) and increased the balloon size (30-40 mm) and duration (10-30 min) in subsequent sessions if the first session was unsuccessful.ResultsThe review found that 1756 patients underwent either LSG or the first step of a Laparoscopic Duodenal Switch (LDS) (1409 LSG & 356 LDS). Of the 1756 patient 33 patients (24 underwent LSG, and 9 underwent LDS) developed a stricture as a complication of LSG. The average age of the patients was 46.4 (±9.6) years, and the average BMI was 43.7 (±6.4). The most common location for stricture was mid-body of the sleeve (54.5%). The average time from the primary surgery to diagnosis and first pneumatic dilation was 5.6 months (± 6.8) and 5.9 months (± 6.6) respectively. We successfully used pneumatic dilation in 31 (93.9%) of these patients to relieve the stricture.ConclusionWe conclude that pneumatic dilation is an effective procedure in patients with post sleeve gastrectomy stricture.

Modificaciones anatómicas de la derivación biliopancreática con cruce duodenal: ¿Tienen algún rol futuro en la cirugía bariátrica y metabólica?

“…Sin embargo, no hubo diferencias significativas entre estas dos cirugías cuando se compararon parámetros nutricionales, tales como vitamina D, B1, B12, calcio, albúmina sérica, proteínas séricas totales, y parámetros metabólicos como glicemia en ayuno, hemoglobina glicosilada, insulina basal, y perfil lipídico 19 . Recientemente Zaveri et al, publicaron una serie de 437 pacientes que se sometieron a SIPS 20 . A los 4 años de seguimiento, los pacientes tuvieron un promedio de %PEP de 86%.…”

“…Ocho pacientes desarrollaron complicaciones relacionadas con el largo del asa eferente (7 con diarrea, 1 hipoproteinemia), por lo tanto, se requirió alargamiento de dicho segmento del intestino delgado. La remisión de DM, dislipidemia, hipertensión arterial, y apnea del sueño, a los 4 años de seguimiento, fue 81,3, 70,5, 71, y 64%, respectivamente 20 .…”

Endoscopic balloon dilation for treatment of sleeve gastrectomy stenosis: a systematic review and meta-analysis

“…Logically, a more rigid balloon with a larger diameter would be more likely to tear the stenotic tissue in the stricture zone, yielding a higher success rate. 8,25,26 Additionally, an increased duration time of 15 to 20 minutes per dilation using the larger balloon in the initial attempt could better overcome the elasticity of the fibrosis that occurs in these stricture sites, thus leading to higher success rates as in the case of Dhorepatil et al 26 Although anecdotal evidence from various dual-balloon studies may suggest superiority of the achalasia balloon, the type of balloon used may ultimately depend on accessibility and length of stenosis of SGS. For instance, although Shnell et al 21 reported higher success with the achalasia balloon, they were unable to position the larger balloon appropriately in the distal SGS cases because of limited access of the introducer in a twisted SGS.…”

Endoscopía luego de cirugía bariátrica: Lo que debe saber el endoscopista

“…En el caso de las estenosis post gVt, la tasa de éxito va desde 44% a 100% 71,72 y pueden ser manejadas con dilatación con balón o posicionamiento de stents. La tabla 3 67,[71][72][73][74][75][76][77][78][79] resume las series publicadas para el manejo de las estenosis post gVt y sus resultados.…”