title: Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery.
abstract: BACKGROUND
  Roux-en-Y gastric bypass is a commonly used technique of bariatric surgery. One of the most important complications is gastrojejunal anastomotic stricture. Endoscopic balloon dilation appears to be well tolerated and effective, but well-designed randomized, controlled trials have not yet been conducted.
  
  
  OBJECTIVE
  Identify factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery.
  
  
  METHODS
  Gastrointestinal endoscopy service, university hospital, Brazil.
  
  
  METHODS
  The records of 64 patients with anastomotic stricture submitted to endoscopic dilation with hydrostatic balloon dilation were reviewed. Information was collected on gastric pouch length, anastomosis diameter before dilation, number of dilation sessions, balloon diameter at each session, anastomosis diameter after the last dilation session, presence of postsurgical complications, endoscopic complications, and outcome of dilation. Comparisons were made among postsurgical and endoscopic complications; number of dilations, balloon diameter; anastomosis diameter before dilation; and dilation outcome.
  
  
  RESULTS
  Success of dilation treatment was 95%. Perforation was positively and significantly associated with the number of dilation sessions (P = .03). Highly significant associations were found between ischemic segment and perforation (P<.001) and between ischemic segment and bleeding (P = .047). Ischemic segment (P = .02) and fistula (P = .032) were also associated with dilation failure.
  
  
  CONCLUSIONS
  Ischemic segment and fistula were found to be important risk factors for balloon dilation failure. The greater the number of dilation sessions, the greater the number of endoscopic complications.
authors.affiliation: Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Gastrointestinal Endoscopy Service, Hospital São Luiz Morumbi, São Paulo, Brazil.
authors.forename: Eduardo G H
authors.initials: EGH
authors.lastname: de Moura
authors.affiliation: Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Gastroclínica Cascavel - Assis Gurgacz Medical School, Paraná, Brazil. Electronic address: ivan@gastro.com.br.
authors.forename: Ivan R B
authors.initials: IRB
authors.lastname: Orso
authors.affiliation: Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Eduardo F
authors.initials: EF
authors.lastname: Aurélio
authors.affiliation: Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Eduardo T H
authors.initials: ETH
authors.lastname: de Moura
authors.affiliation: Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Diogo T H
authors.initials: DTH
authors.lastname: de Moura
authors.affiliation: Gastrointestinal Endoscopy Service, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Santo
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D003251:Constriction, Pathologic / Q000209:etiology; D004106:Dilatation / Q000009:adverse effects* / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D005260:Female; D015905:Gastric Balloon / Q000009:adverse effects; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D007511:Ischemia / Q000209:etiology; D007579:Jejunal Diseases / Q000209:etiology; D007583:Jejunum / Q000098:blood supply; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: Bariatric surgery; Endoscopic dilation; Endoscopy; Morbid obesity; Stenosis