title: Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos).
abstract: BACKGROUND
  Silastic rings are used in gastric bypass procedures for the treatment of obesity, but ring slippage may lead to gastric pouch outlet stenosis (GPOS). Conventional management has been ring removal through abdominal surgery.
  
  
  OBJECTIVE
  To describe a novel, safe, minimally invasive, endoscopic technique for the treatment of GPOS caused by ring slippage after gastric bypass.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Federal University of Pernambuco and São Paulo University.
  
  
  METHODS
  This study involved 39 consecutive patients who were screened for inclusion.
  
  
  METHODS
  Endoscopic dilation with an achalasia balloon.
  
  
  METHODS
  Technical success and safety of the procedure.
  
  
  RESULTS
  Among the 39 patients, 35 underwent endoscopic dilation at the ring slippage site for the relief of GPOS. The 4 patients who did not undergo endoscopic dilation underwent surgical removal of the ring, based on the exclusion criteria. The endoscopic approach was successful in 1 to 4 sessions in 100% of cases with radioscopic control (n = 12). The duration of the procedures ranged from 5 to 30 minutes, and the average internment was 14.4 hours. Dilation promoted either rupture (65.7%) or stretching (34.3%) of the thread within the ring, thereby increasing the luminal diameter of the GPOS. Complications included self-limited upper digestive tract hemorrhage (n = 1) and asymptomatic ring erosion (n = 4). There were no recurrences of obstructive symptoms during the follow-up period (mean of 33.3 months).
  
  
  CONCLUSIONS
  This was not a randomized, comparison study, and the number of patients was relatively small.
  
  
  CONCLUSIONS
  The technique described promotes the relief of GPOS with low overall morbidity and avoids abdominal reoperation for ring removal.
authors.affiliation: Department of Surgery, Federal University of Pernambuco, Recife, Brazil. berg@elogica.com.br
authors.forename: Josemberg Marins
authors.initials: JM
authors.lastname: Campos
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Evangelista
authors.forename: Alvaro Antônio B
authors.initials: AA
authors.lastname: Ferraz
authors.forename: Manoel P
authors.initials: MP
authors.lastname: Galvao Neto
authors.forename: Eduardo Guimarães H
authors.initials: EG
authors.lastname: De Moura
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Edmundo M
authors.initials: EM
authors.lastname: Ferraz
mesh_terms: D000328:Adult; D002404:Catheterization / Q000009:adverse effects; D004129:Dimethylpolysiloxanes; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000628:therapy*; D015390:Gastric Bypass / Q000295:instrumentation*; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019736:Prostheses and Implants; D011859:Radiography; D014741:Video Recording
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon