title: Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery.
abstract: BACKGROUND
  The aim of this study was to describe the endoscopic findings in patients with upper GI symptoms after Roux-en-Y gastric bypass surgery and to correlate clinical features with endoscopic findings.
  
  
  METHODS
  Patients with symptoms after Roux-en-Y gastric bypass referred for endoscopy were studied. Endoscopy was performed in standard fashion with a 9.8-mm diameter endoscope.
  
  
  RESULTS
  Forty-nine patients underwent a total of 69 upper endoscopy procedures between January 2001 and February 2003. The most common endoscopic findings were the following: normal post-surgical anatomy (21 patients, 43%), marginal ulcer (13 patients, 27%), stomal stenosis (9 patients [19%], including 5 with a concomitant marginal ulcer), and staple-line dehiscence (8 patients [16%], including one with a marginal ulcer). Abdominal pain was the most common symptom (26 patients, 53%) and was more frequent among patients with a normal endoscopy compared with those with an abnormal endoscopy (p=0.04). Stomal stenosis was present in 39% of patients with nausea, vomiting, or dysphagia; it was not present in any patient without these symptoms (p=0.001). Fifteen percent of procedures performed within the first 6 postoperative months were normal, compared with 53% of those performed beyond 6 months (p=0.02). There was no complication of endoscopy.
  
  
  CONCLUSIONS
  Among patients with symptoms after Roux-en-Y gastric bypass presenting for endoscopy, normal post-surgical anatomy was the most common finding. Marginal ulcer was the most common abnormality. Presentation with abdominal pain and performance of endoscopy beyond the 6th post-operative month were predictive of a normal endoscopy, and lack of nausea, vomiting, and dysphagia predicted the absence of stomal stenosis.
authors.affiliation: Section of Gastroenterology, Department of Surgery, Boston Medical Center, Boston, Massachusetts 02118, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Huang
authors.forename: R Armour
authors.initials: RA
authors.lastname: Forse
authors.forename: Brian C
authors.initials: BC
authors.lastname: Jacobson
authors.forename: Francis A
authors.initials: FA
authors.lastname: Farraye
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D002404:Catheterization; D003251:Constriction, Pathologic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013276:Stomach Ulcer / Q000175:diagnosis*