Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass |
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Authors: | Andrew Ukleja Bianca B Afonso Ronnie Pimentel Samuel Szomstein Raul Rosenthal |
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Institution: | (1) Department of Gastroenterology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA;(2) Department of Internal Medicine, Cleveland Clinic, Weston, FL, USA;(3) Department of Minimally Invasive Surgery, Cleveland Clinic, Weston, FL, USA |
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Abstract: | Objective Stricture formation at the gastrojejunal anastomosis is a relatively common complication after laparoscopic Roux-en-Y gastric
bypass (LRYGB). The objective of this study was to report the incidence of stomal strictures after LRYGB in our institution
and report our experience with their management by endoscopic balloon dilatation.
Methods This is a retrospective study of 1012 patients who underwent LRYGB from January 2001 to May 2004. Patients with nausea and
vomiting after the surgery, suspected of having gastrojejunal (GJ) anastomotic stricture, had upper endoscopy. Stomas less
than 10 mm in diameter, or those not allowing passage of the scope were considered significant strictures and were treated
with balloon dilations. Dilations were performed with a through-the-scope (TTS) balloon, with sizes ranging from 6 to 18 mm.
The following data were collected from these patients: age, sex, body mass index (BMI), comorbidities, size of balloon catheter,
time from surgery until symptoms onset, number of endoscopies needed to relief symptoms, and complications of the procedure.
Results Sixty-one patients (46 females and 15 males) were found to have anastomotic strictures, corresponding to an incidence of 6%.
In total, 134 upper endoscopies were performed, with 128 dilatations. The average age was 41.7 years (range: 19–68 years);
mean preoperative BMI was 45 kg/m2 (range: 42–61 kg/m2). Mean time from surgery to symptoms onset was 2 months (range: 1–6 months). The number of dilations per patient was as follows:
a single dilation in 28% of patients, two dilations in 33%, three dilations in 26%, four dilations in 11.5%, and five dilations
in 1.5% of patients. All the patients responded to dilation without need for formal surgical revision. However, after balloon
dilatation three patients (4.9%), all females, had bowel perforation by radiological criteria (free air on X-ray), which corresponded
to 2.2% of all dilatations. The maximum balloon size used in this group was 13.5 mm. All three patients had exploratory laparoscopy
without finding of perforation site. They were treated with bowel rest, intravenous antibiotics for 7 days, and drain placement.
No factors were identified to predict a risk of perforation.
Conclusion This is the largest study to evaluate the outcome of endoscopic dilatations of GJ strictures after RYGB. Endoscopic balloon
dilation is a safe and effective treatment for anastomotic strictures. However, it carries a small risk of perforation. Further
case studies are needed to determine risk factors for perforation and if the patients can be managed conservatively in this
setting. |
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Keywords: | Bariatric Surgical– Technical G-I endoscopy Endoscopy |
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