Introduction: Gastrojejunal (GJ) stricture is a relatively common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Aim of this study was to report the GJ strictures rate after LRYGB at our institution and their endoscopic management. Methods: This is a retrospective study of 278 patients (216 females, 62 males) submitted to LRYGB from April 2001 to June 2009. Seventy-seven had a trans-oral circular stapled anastomosis, 151 a totally intra-abdominal technique, 38 a roboticassisted hand-sewn anastomosis, and 2 a hand-sewn anastomosis. Patients who experienced nausea, dysphagia or vomiting after surgery underwent upper endoscopy. Any anastomosis not allowing passage of the standard scope was considered stenotic and treated with balloon dilations. Dilations were performed in all cases with a through-the-scope balloon, with sizes ranging 12-20 mm. The following data were collected from patients: age, sex, BMI, size of balloon catheter, time from surgery until symptoms onset, number of endoscopies needed to relief symptoms, and procedure complications. Results: Twenty patients (15 females, 5 males) were found to have GJ strictures, corresponding to an overall incidence of 7.2%, homogeneously distributed among the different procedures. Patients who experienced stricture showed a mean age of 34.9 years and a mean preoperative BMI of 48.2 kg/ m2, while patients who did not experienced stricture had mean age 41.2 years (p = 0.010) and mean BMI 46.9 kg/ m2 (p NS). No other variable investigated showed significant differences between groups. Mean time between surgery and first endoscopic treatment was 47 days (range: 14-72). The number of dilations per patient were: a single dilation in 12 (60%) patients, two dilations in 4 (20%), three dilations in 3 (15%), four dilations in 1 (5%) who required then a surgical revision at 9 months from surgery. All other patients completely responded to dilation within 90 days from surgery. No endoscopic complication was observed. Conclusions: GJ anastomosis stricture is an early complication after LRYGB, which can be safely managed by endoscopic balloon dilation with a 95% success rate and no endoscopic-related morbidity.
Endoscopic management of Roux-en-Y gastric bypass gastrojejunal strictures
AREZZO, Alberto;SCOZZARI, Gitana;TOPPINO, Mauro;MORINO, Mario
2011-01-01
Abstract
Introduction: Gastrojejunal (GJ) stricture is a relatively common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Aim of this study was to report the GJ strictures rate after LRYGB at our institution and their endoscopic management. Methods: This is a retrospective study of 278 patients (216 females, 62 males) submitted to LRYGB from April 2001 to June 2009. Seventy-seven had a trans-oral circular stapled anastomosis, 151 a totally intra-abdominal technique, 38 a roboticassisted hand-sewn anastomosis, and 2 a hand-sewn anastomosis. Patients who experienced nausea, dysphagia or vomiting after surgery underwent upper endoscopy. Any anastomosis not allowing passage of the standard scope was considered stenotic and treated with balloon dilations. Dilations were performed in all cases with a through-the-scope balloon, with sizes ranging 12-20 mm. The following data were collected from patients: age, sex, BMI, size of balloon catheter, time from surgery until symptoms onset, number of endoscopies needed to relief symptoms, and procedure complications. Results: Twenty patients (15 females, 5 males) were found to have GJ strictures, corresponding to an overall incidence of 7.2%, homogeneously distributed among the different procedures. Patients who experienced stricture showed a mean age of 34.9 years and a mean preoperative BMI of 48.2 kg/ m2, while patients who did not experienced stricture had mean age 41.2 years (p = 0.010) and mean BMI 46.9 kg/ m2 (p NS). No other variable investigated showed significant differences between groups. Mean time between surgery and first endoscopic treatment was 47 days (range: 14-72). The number of dilations per patient were: a single dilation in 12 (60%) patients, two dilations in 4 (20%), three dilations in 3 (15%), four dilations in 1 (5%) who required then a surgical revision at 9 months from surgery. All other patients completely responded to dilation within 90 days from surgery. No endoscopic complication was observed. Conclusions: GJ anastomosis stricture is an early complication after LRYGB, which can be safely managed by endoscopic balloon dilation with a 95% success rate and no endoscopic-related morbidity.
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