Stenosis in gastric bypass: Endoscopic management

Abstract

Gastric bypass is a treatment option for morbid obesity. Stenosis of the gastrojejunal anastomosis is a recognized complication. The pathophysiological mechanisms involved in the formation of stenosis are not well known. Gastrojejunal strictures can be classified based on time of onset, mechanism of formation, and endoscopic aspect. Diagnosis is usually obtained by endoscopy. The two main treatment alternatives for stomal stricture are: endoscopic dilatation (balloon or bouginage) and surgical revision (open or laparoscopic). Both techniques of dilation [through-the-scope (TTS) balloon dilators, Bougienage dilators] are considered safe, effective, and do not require hospitalization. The optimal technique for dilation of stomal strictures remains to be determined, but many authors prefer the use of TTS balloon catheters. Most patients can be successfully treated with 1 or 2 sessions. The need for reconstructive surgery of a stomal stricture is extremely rare.

A modular magnetic anastomotic device for minimally invasive digestive anastomosis: proof of concept and preliminary data in the pig model

“…8 Relationship between magnetic force and burst pressure. No significant correlation between magnetic force exerted by magnets and burst pressure (R 2 = 0.4399) of all specimens was found and bariatric surgery (gastrojejunal anastomosis related to Roux-en-Y gastric bypass) in 3-27 % of cases [26].…”

Long term results of the use of compression anastomosis clips (CAC) in gastrointestinal surgery – the first report

“…Ischemia, the presence of ulcers in the anastomosis, the jejuno biliary reflux to the stomach, scar retraction, and an inappropriate surgical technique -to name some of them (6). Among the factors related to surgical technique having an impact on stenosis occurrence in gastroenterostomy one may enumerate the diameter of a circular stapler used in the procedure, retrocolic or antecolic positioning of the Roux loop and the original dimension of the anastomosis (6). Anastomoses performed using the CAC was characterised by a smooth, wellhealed line of anastomosis in the form of very thin circular tissue layer (15, 16).…”

“…The range of scar tissue is proportional to the quantity of the granulation tissue, which creates it (16,19). Because in most patients the stenosis of anastomosis occurs in period of 3 months from the date of its formation, the evaluation of anastomosis carried out by us after 6 months allows to conclude that the compression clips form anastomoses which maintain a valid patency in the postoperative period (6).…”

“…The width of the anastomoses performed was evaluated according to the four-point stenosis scale (6). I 0 stenosis-mild, allowing for the passage of a 10.5 mm endoscope through the anastomosis; II 0 stenosis-moderate, allowing for the passage of an 8.5 mm pediatric endoscope; III 0 stenosis-severe, allowing for the passage of a guide; and IV 0 stenosis-full, impenetrable to an endoscope (6). The performed CT scans and radiographic examination of the upper gastrointestinal tract with contrast were used to evaluate the passage of contrast through the earlier performed anastomoses.…”

Diagnose und Management iatrogener endoskopischer Perforationen: Positionspapier der Europäischen Gesellschaft für Gastrointestinale Endoskopie (ESGE)

“…In einer kleinen Serie (n = 13) mit Dilatation von Crohn-Stenosen durch DBE wurde eine Perforation beobachtet [140]. Nach Dilatation von Anastomosenstrikturen nach Bypass-Operationen werden iatrogene Perforationen in 0 -4,5 % beobachtet [141]. • " Abb.…”