title: Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention.
abstract: OBJECTIVE
  To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG).
  
  
  METHODS
  VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.
  
  
  RESULTS
  Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.
  
  
  CONCLUSIONS
  Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.
authors.affiliation: Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
authors.forename: Anand
authors.initials: A
authors.lastname: Nath
authors.affiliation: Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
authors.forename: Sayali
authors.initials: S
authors.lastname: Yewale
authors.affiliation: Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
authors.forename: Tung
authors.initials: T
authors.lastname: Tran
authors.affiliation: Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
authors.forename: John S
authors.initials: JS
authors.lastname: Brebbia
authors.affiliation: Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Shope
authors.affiliation: Anand Nath, Department of Medicine, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Koch
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D006874:Hydrostatic Pressure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000601:surgery*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bariatric surgery; Dysphagia; Obesity; Stomach dilatation; Vertical sleeve gastrectomy