title: Endoscopic dilation of gastrojejunal anastomosis after gastric bypass.
abstract: BACKGROUND
  Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication.
  
  
  OBJECTIVE
  Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates.
  
  
  METHODS
  The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded.
  
  
  RESULTS
  The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain.
  
  
  CONCLUSIONS
  Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings.
authors: Universidade Federal de Pernambuco, Recife, PE, Brazil. josembergcampos@gmail.com
authors: Josemberg Marins
authors: JM
authors: Campos
authors: Fernando Salvo Torres de
authors: FS
authors: Mello
authors: Alvaro Antonio Bandeira
authors: AA
authors: Ferraz
authors: Júlia Nóbrega de
authors: JN
authors: Brito
authors: Paulo Afonso Nunes
authors: PA
authors: Nassif
authors: Manoel dos Passos
authors: Mdos P
authors: Galvão-Neto
mesh_terms: D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D015390:Gastric Bypass; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D013270:Stomach / Q000601:surgery*