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Endoscopic severity of gastric sleeve stenosis can be quantified using impedance planimetry

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Abstract

Background

Gastric sleeve stenosis (GSS) is an adverse event following sleeve gastrectomy for which objective tools are needed for diagnosis and treatment. Endoscopic treatment with serial pneumatic balloon dilation may relieve symptoms and prevent the need for conversion to Roux-en-Y gastric bypass. Endoluminal functional impedance planimetry (EndoFLIP) is an endoscopic tool that measures luminal diameter and distensibility indices (DI) and could be used to characterize severity of GSS.

Methods

This was a retrospective analysis of a prospective database of patients referred for symptoms suggestive of GSS. Severity was determined at each endoscopy by a bariatric endoscopist blinded to EndoFLIP measurements. Successive pneumatic balloon dilations were performed until symptoms resolved; failure was defined as referral for conversion. EndoFLIP measurements of stenosis diameter and DI were obtained pre- and post-dilation. Primary outcomes were pre- and post-dilation luminal diameter and DI of GSS. Secondary outcomes were endoscopic severity of GSS, patient characteristics, and need for surgical revision.

Results

26 patients were included; 23 (85%) were female. Mean age was 45.3 (± 9.9) years. Mean number of dilations was 2.4 (± 1.3) and 10 (38%) patients were referred for conversion. Mild, moderate, and severe GSS was found in 10 (38%), 6 (23%), and 10 (38%) patients, respectively. Moderate and severe GSS underwent more dilations (2.5 ± 1.0 and 3.2 ± 1.6) than mild GSS (1.8 ± 0.8) and were more likely to be referred for conversion. Both pre- and post-dilation diameters were significantly larger in mild versus moderate or severe GSS. Additionally, pre- and post-dilation DI at 30 ml were significantly higher for mild compared to moderate and severe GSS.

Discussion

EndoFLIP measurements correlate well with endoscopic assessment of GSS. While more data are needed to determine ideal balloon size and threshold measurements, our results suggest EndoFLIP may help expedite diagnosis and treatment of GSS.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Dr., 3912 Taubman Center, Ann Arbor, MI, 48109-5362, USA

    Jessica X. Yu, Gretchen Evans, Sarah Volk, Lydia Watts & Allison R. Schulman

  2. Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA

    Jessica X. Yu

  3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Allison R. Schulman

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  1. Jessica X. Yu
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  2. Gretchen Evans
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Correspondence to Allison R. Schulman.

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Disclosures

Allison R. Schulman MD, MPH reports consultancy fees on behalf of Boston Scientific, Apollo Endosurgery, Olympus, and MicroTech; she receives funding support for research/grants involving GI Dynamics and Fractyl. Jessica X. Yu MD, MS; Gretchen Evans MD, MPH; Sarah Volk, BS; and Lydia Watts, BA have no conflicts of interest or financial ties to disclose

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Yu, J.X., Evans, G., Volk, S. et al. Endoscopic severity of gastric sleeve stenosis can be quantified using impedance planimetry. Surg Endosc 37, 5969–5974 (2023). https://doi.org/10.1007/s00464-023-10077-y

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  • DOI: https://doi.org/10.1007/s00464-023-10077-y

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