Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass

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.…”

“…Laparoscopic bypass has clear advantages over open surgery, however, the possibility remains, in a variable percentage, of the appearance of stenosis of the gastro-jejunal anastomosis. The pathophysiological mechanisms involved in the formation of stenosis are not well known, although situations such as stoma ulcer, reflux, ischemia of the suture, retraction of the scar, or an inadequate technique, may contribute to its appearance (2,5). Considering the uncertainty of the pathophysiology of stenosis, as a lesser evil is to know that it is an infrequent complication and that the endoscopic treatment achieves a correct and quick resolution of the problem, in most cases, without the need for another surgical intervention.…”

“…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.…”

Role of Endoscopy in Laparoscopic Procedures

“…Stomal stenosis is the one of the most frequent complications after Laparoscopic Roux en Y Gastric Bypass ( RYGBP) [31]. Stomal stenosis occurs in 1-5% of patients undergoing Laparoscopic RYGBP [32][33][34]. Endoscopic dilation of the stomal stenosis has proven to be successful without the need of surgical revision.…”