Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass.
BACKGROUND
Roux-en-Y gastric bypass is the most frequently performed bariatric surgery for morbid obesity. Gastrojejunal anastomotic strictures are a relatively frequent postoperative complication.


OBJECTIVE
To evaluate the clinical outcomes and therapeutic response to through-the-scope balloon dilation performed to treat anastomotic strictures after Roux-en-Y gastric bypass surgery.


METHODS
Single-center, retrospective study.


METHODS
Academic medical center.


METHODS
Between 1997 and 2005, 801 patients with morbid obesity underwent Roux-en-Y gastric bypass surgery at our institution.


METHODS
The development of an anastomotic stricture after Roux-en-Y gastric bypass surgery. The response to through-the-scope balloon dilation after diagnosis.


RESULTS
Forty-three of 801 patients (5.4%) developed an anastomotic stricture (26 of 294 open surgeries [8.8%]; 17 of 507 laparoscopic surgeries [3.4%]; P < .001). Strictures were dilated to 15.5 +/- 0.4 mm. There were no perforations or clinically significant bleeding after dilation; 93% of the strictures were successfully managed with 1 or 2 endoscopic sessions. Dilation to at least 15 mm did not affect weight loss at 1 year when compared with the group without a stricture (percentage excess weight loss: stricture group, 76%; no stricture group, 74%).


CONCLUSIONS
Single-center, retrospective study.


CONCLUSIONS
Endoscopic balloon dilation is a safe and effective method for the management of gastrojejunostomy strictures after Roux-en-Y gastric bypass. Dilation to at least 15 mm is safe and decreases the need for further endoscopic dilation.
Peifer
Kevin J
KJ
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Shiels
Aaron J
AJ
Azar
Riad
R
Rivera
Ramon E
RE
Eagon
J Chris
JC
Jonnalagadda
Sreenivasa
S
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002404:Catheterization; D003251:Constriction, Pathologic / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*