title: Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos).
abstract: BACKGROUND
  A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%-4% of cases.
  
  
  OBJECTIVE
  To report our experience, results, and long-term follow-up after pneumatic dilation of late functional helix stenosis after laparoscopic sleeve gastrectomy.
  
  
  METHODS
  Multicenter study led by an endoscopic tertiary referral center.
  
  
  METHODS
  Thirty-five patients were dilated initially at 30 mm. Thirteen out of 35 patients underwent a second dilation up to 35 mm. Only 8 patients underwent a third pneumatic dilation up to 40 mm. The stricture was localized in the mid-body of the sleeve in 32 patients overall; 3 had narrowing adjacent to the cardia. Eleven twists formed an acute angle between the 2 segments of the stomach, whereas 24 angles were obtuse. Seven out of 35 patients presented with persistent dilated pouch above the twist. Two patients were lost to follow-up. Overall outcome at an average follow-up of 15.5 months after primary surgery (range 7-49 mo) was as follows: 12 clinical failures and 1 technical failure (40%) and 60% (20 out of 33) clinical success.
  
  
  CONCLUSIONS
  Pneumatic dilation of late functional helix stricture is an effective technique for treatment of dysphagia in the majority of patients treated. Complete helix stricture, defined in function of the angle within twist, as well as the presence of a persistently dilated gastric pouch above the kinking, seems to be correlated with higher failure rates.
authors.affiliation: Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France. Electronic address: donatelligianfranco@gmail.com.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
authors.affiliation: Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Dumont
authors.affiliation: Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors.forename: Guillame
authors.initials: G
authors.lastname: Pourcher
authors.affiliation: Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors.forename: Hadrien
authors.initials: H
authors.lastname: Tranchart
authors.affiliation: Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Tuszynski
authors.affiliation: Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dagher
authors.affiliation: Service de Chirurgie Viscérale, Centre Hôspitalier de Saint-Denis, Saint-Denis, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Catheline
authors.affiliation: Service de Chirurgie Viscérale, Clinique Geoffry Sant Hilaire, Ramsay Générale de Santé, Paris, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Chiche
authors.affiliation: Service de Chirurgie Digestive et Viscérale, Hôpital Universitaire Bichat - Claude Bernard - AP-HP, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
authors.affiliation: Service de Gastroenterologie, Hôpital René Dubos, Pontoise, France.
authors.forename: Stavros
authors.initials: S
authors.lastname: Dritsas
authors.affiliation: Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Bertrand-Marie
authors.initials: BM
authors.lastname: Vergeau
authors.affiliation: Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meduri
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D050110:Bariatric Surgery / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000628:therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004106:Dilatation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D013272:Stomach Diseases / Q000209:etiology / Q000628:therapy*; D014102:Torsion Abnormality / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Gastric stricture; Helix stricture; Sleeve gastrectomy; Stenosis; Surgical obesity; Twist