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Incidence and risk factors for early gastrojejunostomy anastomotic stricture requiring endoscopic intervention following laparoscopic Roux-en-Y gastric bypass: a MBSAQIP analysis

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Abstract

Background

Gastrojejunostomy (GJ) stricture is one of the most commonly recognized complications following laparoscopic Roux-en-Y gastric bypass (LRYGB). The risks involving the formation of early GJ stomal stenosis are largely unknown. The aims of this study are to evaluate the rate and risk factors associated with GJ stricture in patients requiring esophagogastroduodenoscopy (EGD) within 30 days after LRYGB.

Methods

This is a retrospective study of patients who underwent EGD for GJ stricture following LRYGB. Data were retrieved from MBSAQIP database from 2015 to 2018. Descriptive, bivariate, and logistic regression analyses were performed. Those who had reoperation, readmission, and intervention for other indications rather than GJ stricture were excluded from the risk factor analysis.

Results

760,076 patients underwent bariatric surgery. Of these, 184,660 (24.3%) underwent LRYGB and 875 had GJ stricture within 30 days postoperatively. The overall incidence of early GJ stricture after LRYGB was 4.7 per 1000 person-years. The incidence decreased from 6.2 to 3.4 per 1000 person-years during the 4-year period. 85% of patients with GJ stricture required therapeutic intervention. Median (IQR) day to the first endoscopic intervention was 25 (21–28) days. The overall 30-day readmission rate was 40%. 30-day reoperation rate due to GJ stricture was 5.6%. No 30-day mortality occurred. Factors independently associated with an increased risk for early GJ stricture include concurrent hiatal hernia repair (Adjusted Odds Ratio—AOR 1.8, 95% CI 1.5–2.2), revision case (AOR 1.4, 95% CI 1.1–1.6), African American (AOR 1.4, 95% CI 1.2–1.7), gastroesophageal reflux disease—GERD (AOR 1.4, 95% CI 1.2–1.5), drain placement (AOR 1.3, 95% CI1.1–1.4), and routine postoperative swallow study (AOR 1.3, 95% CI 1.1–1.50).

Conclusion

The incidence of early GJ stricture following LRYGB decreased at MBSAQIP-accredited centers over the review period. Patients having additional manipulation at or around GJ were at risk of developing early GJ stricture after LRYGB.

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References

  1. Papasavas PK, Caushaj PF, McCormick JT, Quinlin RF, Hayetian FD, Maurer J, Kelly JJ, Gagné DJ (2003) Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc Other Interv Tech 17:610–614

    Article  CAS  Google Scholar 

  2. Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients–what have we learned? Obes Surg 10:509–513

    Article  CAS  Google Scholar 

  3. Almby K, Edholm D (2019) Anastomotic strictures after Roux-en-Y Gastric Bypass: a cohort study from the scandinavian obesity surgery registry. Obes Surg 29:172–177

    Article  Google Scholar 

  4. Giordano S, Salminen P, Biancari F, Victorzon M (2011) Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg 21:1958–1964

    Article  Google Scholar 

  5. Markar SR, Penna M, Venkat-Ramen V, Karthikesalingam A, Hashemi M (2012) Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity. Surg Obes Relat Dis 8:230–235

    Article  Google Scholar 

  6. Mueller CL, Jackson TD, Swanson T, Pitzul K, Daigle C, Penner T, Urbach DR, Okrainec A (2013) Linear-stapled gastrojejunostomy with transverse hand-sewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y gastric bypass. Obes Surg 23:1302–1308

    Article  Google Scholar 

  7. Ribeiro-Parenti L, Arapis K, Chosidow D, Dumont JL, Demetriou M, Marmuse JP (2015) Gastrojejunostomy stricture rate: comparison between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 11:1076–1084

    Article  Google Scholar 

  8. Barba CA, Butensky MS, Lorenzo M, Newman R (2003) Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass. Surg Endosc 17:416–420

    Article  CAS  Google Scholar 

  9. Go MR, Muscarella P 2nd, Needleman BJ, Cook CH, Melvin WS (2004) Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc 18:56–59

    Article  CAS  Google Scholar 

  10. Ukleja A, Afonso BB, Pimentel R, Szomstein S, Rosenthal R (2008) Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc 22:1746–1750

    Article  Google Scholar 

  11. Mathew A, Veliuona MA, DePalma FJ, Cooney RN (2009) Gastrojejunal stricture after gastric bypass and efficacy of endoscopic intervention. Dig Dis Sci 54:1971–1978

    Article  Google Scholar 

  12. Cusati D, Sarr M, Kendrick M, Que F, Swain JM (2011) Refractory strictures after Roux-en-Y gastric bypass: operative management. Surg Obes Relat Dis 7:165–169

    Article  Google Scholar 

  13. Ahmad J, Martin J, Ikramuddin S, Schauer P, Slivka A (2003) Endoscopic balloon dilation of gastroenteric anastomotic stricture after laparoscopic gastric bypass. Endoscopy 35:725–728

    Article  CAS  Google Scholar 

  14. Carrodeguas L, Szomstein S, Zundel N, Lo Menzo E, Rosenthal R (2006) Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis 2:92–97

    Article  Google Scholar 

  15. Csendes A, Burgos AM, Burdiles P (2009) Incidence of anastomotic strictures after gastric bypass: a prospective consecutive routine endoscopic study 1 month and 17 months after surgery in 441 patients with morbid obesity. Obes Surg 19:269–273

    Article  Google Scholar 

  16. Da Costa M, Mata A, Espinós J, Vila V, Roca JM, Turró J, Ballesta C (2011) Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass. Predictors of initial failure. Obes Surg 21:36–41

    Article  Google Scholar 

  17. Peifer KJ, Shiels AJ, Azar R, Rivera RE, Eagon JC, Jonnalagadda S (2007) Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc 66:248–252

    Article  Google Scholar 

  18. Rossi TR, Dynda DI, Estes NC, Marshall JS (2005) Stricture dilation after laparoscopic Roux-en-Y gastric bypass. Am J Surg 189:357–360

    Article  Google Scholar 

  19. Takata MC, Ciovica R, Cello JP, Posselt AM, Rogers SJ, Campos GM (2007) Predictors, treatment, and outcomes of gastrojejunostomy stricture after gastric bypass for morbid obesity. Obes Surg 17:878–884

    Article  Google Scholar 

  20. Goitein D, Papasavas PK, Gagné D, Ahmad S, Caushaj PF (2005) Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 19:628–632

    Article  CAS  Google Scholar 

  21. Nguyen NT, Stevens CM, Wolfe BM (2003) Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg 7:997–1003

    Article  Google Scholar 

  22. McCarty TM, Arnold DT, Lamont JP, Fisher TL, Kuhn JA (2005) Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg 242:494–498

    Article  Google Scholar 

  23. Matthews BD, Sing RF, DeLegge MH, Ponsky JL, Heniford BT (2000) Initial results with a stapled gastrojejunostomy for the laparoscopic isolated roux-en-Y gastric bypass. Am J Surg 179:476–481

    Article  CAS  Google Scholar 

  24. El-Kadre L, Tinoco AC, Tinoco RC, Aguiar L, Santos T (2013) Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis 9:867–872

    Article  Google Scholar 

  25. Perugini RA, Mason R, Czerniach DR, Novitsky YW, Baker S, Litwin DE, Kelly JJ (2003) Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 138:541–545; discussion 545–546.

  26. Kataoka M, Masaoka A, Hayashi S, Honda H, Hotta T, Niwa T, Honda K (1989) Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy. Ann Surg 209:99–104

    Article  CAS  Google Scholar 

  27. Yimcharoen P, Heneghan H, Chand B, Talarico JA, Tariq N, Kroh M, Brethauer SA (2012) Successful management of gastrojejunal strictures after gastric bypass: is timing important? Surg Obes Relat Dis 8:151–157

    Article  Google Scholar 

  28. Patel P, Bhogal R, Rajput A, Elshaw A, Sada P, Khan A, Mirza S (2017) Post Roux-en-Y gastric bypass complications: a comparative study assessing the clinical effectiveness of oesophagogastroduodenoscopy and oral-contrast swallow. Surgeon 15:196–201

    Article  Google Scholar 

  29. Schwartz ML, Drew RL, Roiger RW, Ketover SR, Chazin-Caldie M (2004) Stenosis of the gastroenterostomy after laparoscopic gastric bypass. Obes Surg 14:484–491

    Article  Google Scholar 

  30. Stefanidis D, Malireddy K, Kuwada T, Phillips R, Zoog E, Gersin KS (2013) Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc 27:4504–4510

    Article  CAS  Google Scholar 

  31. Landreneau JP, Strong AT, Rodriguez JH, Aleassa EM, Aminian A, Brethauer S, Schauer PR, Kroh MD (2018) Conversion of sleeve gastrectomy to roux-en-y gastric bypass. Obes Surg 28:3843–3850

    Article  Google Scholar 

  32. Azagury DE, Abu Dayyeh BK, Greenwalt IT, Thompson CC (2011) Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy 43:950–954

    Article  CAS  Google Scholar 

  33. Sverdén E, Mattsson F, Sondén A, Leinsköld T, Tao W, Lu Y, Lagergren J (2016) Risk factors for marginal ulcer after gastric bypass surgery for obesity: a population-based cohort study. Ann Surg 263:733–737

    Article  Google Scholar 

  34. Smith CD, Herkes SB, Behrns KE, Fairbanks VF, Kelly KA, Sarr MG (1993) Gastric acid secretion and vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity. Ann Surg 218:91–96

    Article  CAS  Google Scholar 

  35. Barr AC, Lak KL, Helm MC, Kindel TL, Higgins RM, Gould JC (2019) Linear vs. circular-stapled gastrojejunostomy in Roux-en-Y gastric bypass. Surg Endosc 33:4098–4101

    Article  Google Scholar 

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Acknowledgements

The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and the centers participating in the ACS MBSAQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, Box 956904, 72-239 CHS, Los Angeles, CA, 90095, USA

    Usah Khrucharoen, Zachary N. Weitzner, Yijun Chen & Erik P. Dutson

  2. UCLA Center for Obesity and METabolic Health (COMET), Los Angeles, CA, USA

    Usah Khrucharoen, Zachary N. Weitzner, Yijun Chen & Erik P. Dutson

  3. UCLA Center for Advanced Surgical & Interventional Technology (CASIT), Los Angeles, CA, USA

    Usah Khrucharoen, Zachary N. Weitzner & Erik P. Dutson

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  1. Usah Khrucharoen
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Correspondence to Erik P. Dutson.

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Usah Khrucharoen, Zachary Weitzner, Yijun Chen, and Erik Dutson have no conflict of interest or financial ties to disclose.

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Khrucharoen, U., Weitzner, Z.N., Chen, Y. et al. Incidence and risk factors for early gastrojejunostomy anastomotic stricture requiring endoscopic intervention following laparoscopic Roux-en-Y gastric bypass: a MBSAQIP analysis. Surg Endosc 36, 3833–3842 (2022). https://doi.org/10.1007/s00464-021-08700-x

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