Endoscopic balloon dilation of anastomotic strictures occurring after laparoscopic gastric bypass for morbid obesity.
BACKGROUND
Gastrojejunal anastomotic stenosis of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity occurs in 3-25% of cases. The aim of this report was to evaluate the utility of endoscopic balloon dilation for the therapy of anastomotic strictures after LRYGB.


METHODS
111 consecutive patients were treated with endoscopic dilation under sedation with propofol. Dilations were performed with through-the-scope over-the-wire balloons, with sizes ranging from 6 to 18 mm. The outcomes of the procedure were analyzed.


RESULTS
200 endoscopic balloon dilations were performed in 111 patients. Repeated dilations were necessary in patients with complex stenosis. In 75% of the patients it was possible to dilate to 12 mm during the first session. Only in 2% of the cases was it impossible to introduce the endoscope through the stenosed anastomosis after dilation. On follow-up a repeat dilation was necessary in 26% of the cases. Minor complications occurred in 2.7% of patients (2 concealed perforations and 1 hematoma of the esophagus). These were treated conservatively. None of the patients required operation.


CONCLUSIONS
Endoscopic balloon dilation is a safe and effective therapy for anastomotic strictures occurring after LRYGB.
Caro
Luis
L
GEDyT, Therapeutic and Diagnostic Gastroenterology, Digestive Endoscopy and Gastroenterology at Alexander Fleming Institute, Buenos Aires, Argentina. luiscaro@gedyt.com.ar
Sánchez
Christian
C
Rodríguez
Pablo
P
Bosch
Jorge
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*