title: Food intolerance after banded gastric bypass without stenosis: aggressive endoscopic dilation avoids reoperation.
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGBP) controls obesity and comorbidities. However, there is no consensus on ring placement due to its complications. Surgical ring removal has been the standard approach, despite its inherent morbidity risks. Endoscopic dilation with achalasia balloon is a novel and minimally invasive option. We aimed to evaluate safety and efficacy of aggressive dilation as an outpatient procedure to treat food intolerance after banded RYGBP without stenosis; we also analyzed long-term weight regain.
  
  
  METHODS
  This prospective study included 63 patients presenting with more than four vomiting episodes per week. Therapeutic endoscopy with a 30-mm balloon (Rigiflex®) was performed with radioscopic guidance in the first 16 patients (25.4 %). Four dilation sessions were performed in 12 patients (19 %), three in 14 (22.2 %), two in 24 (38 %), and one in 13 (20.6 %).
  
  
  RESULTS
  Complete symptom improvement was achieved in 59 patients (93.6 %), partial improvement in 2 (3.2 %), and failure in 2, leading to ring removal by laparotomy. Complications rate was 9.5 %, including three cases of bleeding, two intragastric ring erosions, and one pneumoperitoneum; all treated clinically with no need for reintervention. Mean preoperative body mass index (BMI) was 42.4 kg/m(2) and postoperative (before endoscopic treatment) BMI was 25.3 kg/m(2). At a mean follow-up of 46.1 months after endoscopic intervention, mean BMI was 27.8 kg/m(2).
  
  
  CONCLUSIONS
  Aggressive endoscopic dilation for food intolerance is a safe and minimally invasive method that promotes symptom improvement. It avoided reoperation in 96.8 % of patients and led to a low rate of weight regain.
authors.affiliation: Departamento de Cirurgia, Universidade Federal de Pernambuco, Rua Vigário Barreto, 127/802-Graças, 52020-140, Recife, PE, Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Ferraz
authors.forename: Josemberg
authors.initials: J
authors.lastname: Campos
authors.forename: Victor
authors.initials: V
authors.lastname: Dib
authors.forename: Lyz B
authors.initials: LB
authors.lastname: Silva
authors.forename: Patrícia S
authors.initials: PS
authors.lastname: de Paula
authors.forename: Amador
authors.initials: A
authors.lastname: Gordejuela
authors.forename: Felippe
authors.initials: F
authors.lastname: Rolim
authors.forename: Luciana
authors.initials: L
authors.lastname: Siqueira
authors.forename: Manoel
authors.initials: M
authors.lastname: Galvão Neto
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D003251:Constriction, Pathologic / Q000209:etiology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015905:Gastric Balloon; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome