Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass.
BACKGROUND
Common endoscopic findings in patients who have undergone Roux-en-Y gastric bypass (RYGB) with chronic abdominal pain have included marginal ulceration, gastrogastric fistula, and jejunal erosion. However, suture or staples eroding into the gastric pouch can also contribute to abdominal pain. Redundant suture is typically regarded as a normal part of the postoperative anatomy. The objectives of the present study were to assess the effects of endoscopic foreign body removal of partially exposed sutures and staples in post-RYGB patients with chronic abdominal pain at a university hospital in the United States.


METHODS
We performed a retrospective study of consecutive patients from January 2006 to July 2007. Post-RYGB patients with chronic abdominal pain underwent endoscopic foreign body removal of exposed sutures/staples. Pain scores were obtained before the procedure, immediately after the procedure, and at the telephone follow-up (median 7.2 months).


RESULTS
Of 21 patients, 15 (71%) reported immediate symptomatic improvement. Specific endoscopic accessories were found to be more useful than others in managing the various foreign materials. Of the 21 patients, 15 (71%) were available for telephone follow-up. Of these 15 patients, 13 (87%) reported continued symptomatic improvement, with 9 (60%) reporting complete pain resolution and 4 (27%) reporting partial improvement. Eroded foreign material was seen in association with marginal ulcers in 3 patients (14%), gastritis in 7 patients (33%), and an inflammatory polyp in 1 patient (5%).


CONCLUSIONS
Eroded suture and staples can cause chronic abdominal pain in post-RYGB patients. In symptomatic patients, visible suture or staples should be considered a potential etiology of chronic pain, instead of normal postoperative findings. Endoscopic foreign body removal might be of therapeutic benefit in these patients.
Ryou
Marvin
M
Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Mogabgab
Owen
O
Lautz
David B
DB
Thompson
Christopher C
CC
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery*; D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000601:surgery*; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013537:Sutures / Q000009:adverse effects*; D016896:Treatment Outcome