Management of transmesenteric tunnel jejunal strictures with endoscopic dilation by using achalasia balloons (with videos).
BACKGROUND
Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Transmesenteric tunnel (TMT) or mesocolic jejunal stricture is an unusual postoperative complication that requires another operation. We hypothesize that endoscopic dilation by using achalasia dilatation balloons can be used to treat some TMT jejunal strictures.


METHODS
This study involved 6 consecutive cases of TMT stricture.


METHODS
The TMT strictures were dilated by using achalasia balloons (30-40 mm) under fluoroscopic and endoscopic guidance.


RESULTS
With endotherapy, 4 patients with late onset of symptoms (>3 weeks after Roux-en-Y gastric bypass) have not required another operation to date, with a follow-up of at least 5 to 12 months. Two patients with early onset of symptoms (<3 weeks after surgery) required operations, and 1 of these patients (symptoms onset <7 days after surgery) developed jejunal perforation within the stricture during dilation due to underlying jejunal ischemia within the stricture.


CONCLUSIONS
Small case number and limited follow-up period.


CONCLUSIONS
Endoscopic dilation by using achalasia balloons can be used to treat some TMT jejunal strictures without another operation. Surgery should be considered in patients with early onset of obstructive symptoms and/or with jejunal ischemia within the stricture.
Tang
Shou-jiang
SJ
Department of Gastroenterology, Hepatology, and Endoscopy, Trinity Mother Frances Hospitals and Clinics, Tyler, Texas 75702, USA. sjtang2000@yahoo.com
Provost
David A
DA
Livingston
Edward
E
Scott
Daniel J
DJ
D000328:Adult; D002404:Catheterization / Q000295:instrumentation*; D003251:Constriction, Pathologic; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014741:Video Recording