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Gastric Stenosis After Sleeve Gastrectomy: an Algorithm for Management

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Abstract

Background

Gastric stenosis (GS) is a well-recognized complication after sleeve gastrectomy (SG) with a negative impact on patients’ nutritional status and quality of life. There is no consensus on a validated, comprehensive management algorithm for GS. This study evaluates treatment modalities and proposes a management algorithm for obstructive gastric symptoms (OGSs) after SG.

Methods

This is a retrospective cohort study of patients with GS after SG between January 2013 and January 2019. Patients with concomitant GS and staple-line leak were excluded. The primary outcome was the clinical response to treatment.

Results

Forty-nine patients presented with OGSs. One patient underwent urgent surgical treatment for acute migration of cardia. Of 42 patients who had evident GS, pneumatic balloon dilatation (PBD) achieved clinical success in 28 (66.7%) patients. Six patients were diagnosed with indolent GS, and four of them improved after empirical PBD. The mean interval from index surgery to PBD was 5.3 (± 4.2) months. Longer duration of PBD session was associated with better clinical outcomes (5.8 ± 3.7 vs. 3.2 ± 1.7 min) (P = 0.017). After failed PBD, endoscopic stenting (n = 2) and revisional surgery (n = 7) were performed with clinical success in all patients.

Conclusion

PBD using achalasia balloon is the mainstay of treatment with good clinical outcomes. The utility of endoscopic stenting for GS should be different from its use for leakage in aspects of dwelling time and required endoscopic expertise. RYGB is the gold standard revisional procedure due to the high success rate and technical familiarity. Controversial aspects of management require future prospective comparative studies.

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Authors and Affiliations

  1. Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt

    Hosam Hamed, Helmy Ezzat, Mohamed Attia, Amr Sanad & Mohamed El Sorogy

  2. General Surgery Department, Mansoura University, Jehan street, Mansoura, Dakahleyya, Egypt

    Hosam Elghadban

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  1. Hosam Hamed
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  2. Hosam Elghadban
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  6. Mohamed El Sorogy
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Correspondence to Hosam Hamed.

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Hamed, H., Elghadban, H., Ezzat, H. et al. Gastric Stenosis After Sleeve Gastrectomy: an Algorithm for Management. OBES SURG 30, 4785–4793 (2020). https://doi.org/10.1007/s11695-020-04858-w

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  • DOI: https://doi.org/10.1007/s11695-020-04858-w

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