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Obes Surg. 2017 Oct;27(10):2628-2636. doi: 10.1007/s11695-017-2689-3.

An Algorithmic Approach to the Management of Gastric Stenosis Following Laparoscopic Sleeve Gastrectomy.

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
3
Diversity Summer Internship Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
4
Department of Surgery, Herbert Wertheim School of Medicine, Florida International University, Miami, FL, USA.
5
Universidade Federal de Pernambuco, Recife, PE, Brazil.
6
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
7
Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vkumbhari@gmail.com.
8
Division of Gastroenterology and Hepatology, Director of Bariatric Endoscopy Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA. vkumbhari@gmail.com.

Abstract

BACKGROUND:

Gastric stenosis (GS) is a potential adverse event post-laparoscopic sleeve gastrectomy (LSG). Endoscopic management is preferred; however, there is significant variation in therapeutic strategies with no defined algorithm. This study aims to describe the safety and efficacy of a predefined step-wise algorithm for endoscopic management of GS post-LSG.

METHODS:

Consecutive patients with symptomatic GS post-LSG, presenting between July 2015 and August 2016, were subjected to a predefined treatment algorithm of serial dilations using achalasia balloons, followed by a fully covered self-expanding metal stent (FCSEMS) if dilations were inadequate. Patients who did not respond or opted out of ongoing endoscopic therapy were offered revision Roux-en-Y gastric bypass (RYGB).

RESULTS:

Total of 17 patients underwent a median of 2 (range 1-4) balloon dilations. Twelve patients (70.6%) reported clinical improvement with balloon dilation alone, while 3 (17.6%) required subsequent FCSEMS placement. One patient suffered a tear to the muscularis propria with balloon dilation, which was managed conservatively. Overall, 15 (88.2%) reported clinical improvement with endoscopic management. PAGI-SYM scores revealed that the strongest response to therapy, based on mean reduction of score ± SD, was in the following items: nausea (3 ± 1.9, P < 0.001), heartburn during day (2.8 ± 1.5, P = 0.003), heartburn on lying down (3.4 ± 1.4, P < 0.001), reflux during day (2.8 ± 1.9, P < 0.001), and reflux on lying down (3.0 ± 1.9, P < 0.001). Two (11.8%) patients failed endoscopic therapy and underwent RYGB.

CONCLUSIONS:

Endoscopic management of GS using the described algorithmic approach is safe and effective post-LSG. Patients with severe stenosis or helical stenosis are likely to require revision RYGB.

KEYWORDS:

Balloon dilation; Fully covered self-expandable metallic stent; Gastric stenosis; Sleeve gastrectomy

PMID:
28470488
DOI:
10.1007/s11695-017-2689-3
[Indexed for MEDLINE]

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