Abstract
Background and aims
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most frequent technique performed in bariatric surgery. Gastrojejunal anastomotic stricture is one of the most common postoperative complications. The aims of this study were to evaluate the efficacy and safety of endoscopic balloon dilation in the treatment of the gastrojejunal anastomotic strictures after LRYGB and to look for predicting factors that would indicate the need of repeated dilations.
Methods
We included all patients with morbid obesity who underwent a LRYGB at our institution between January 2002 and July 2007. All patients who developed symptoms compatible with stricture of the gastrojejunostomy were referred to upper gastrointestinal endoscopy and underwent endoscopic balloon dilation.
Results
One hundred and five out of the 1,330 patients (7.8%) developed an anastomotic stricture. The mean time to diagnosis was 3 months after the surgery. The mean diameter of the stricture was 5 mm. Sixty out of the 105 patients required only one dilation (57%), 29 required two dilations (27,6%), 13 required three dilations, and 3 patients underwent a fourth dilation. Clinical success was achieved in 100% of the cases, with an average of 1.6 dilations. The statistical analysis showed that only the time from surgery to stricture formation (p = 0.007) and the diameter achieved at the first dilation (p = 0.015) had statistical significance as predictors of the need of one or more dilations.
Conclusions
Endoscopic balloon dilation is a safe and effective method. Most of the patients are successfully managed with one or two dilations. The longer time from surgery to the appearance of symptoms ant the largest diameter achieved at the first dilation are the only predicting factors of success with only one dilation.
References
Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195–200.
Calle EE, Thun MJ, Petrelli JM, et al. Body mass index and mortality in a prospective cohort of US adults. N Engl J Med. 1995;341:1097–105.
Schauer PR, Ikramuddin S. Laparoscopic surgery for morbid obesity. Surg Clin North Am. 2001;81:1145–79.
Steinbrook R. Surgery for severe obesity. N Eng J Med. 2004;350:1075–9.
Nguyen TN, Goldman C, Rosenquist J, et al. Laparoscopic versus open gastric bypass: a randomised study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–91.
Peifer KJ, Shiels A, Azar R, et al. Succesful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc. 2007;66:248–52.
Barba CA, Butensky MS, Lorenzo M, et al. Endoscopic dilation of gastrojejunal anastomosis stricture after gastric bypass. Surg Endosc. 2003;17:416–20.
Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Sug. 2003;7:997–1003.
Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunostomy during laparoscopic gastric bypass; análisis of 3 techniques. Arch Surg. 2003;138:181–4.
Takata MC, Ciovica R, Cello JP, et al. Predictors treatment, and outcomes of gastrojejunostomy stricture after gastric bypass for morbi obesity. Obesity Surg. 2007;17:878–84.
Ahmad J, Martin J, Ikramuddin S, et al. Endoscopic balloon dilation of gastroenteric anastomotic stricture after laparoscopic gastric bypass. Endoscopy. 2003;35:725–8.
Go MR, Muscarella P, Needleman BJ, et al. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc. 2004;18:56–9.
Escalona A, Devaud N, Boza C, et al. Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator. Surg Endosc. 2007;21:765–8.
Fernández Esparrach G, Bordas JM, Llach J, et al. Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparosocopic gastric bypass in morbidly obese patients. Obes Surg. 2008;18:155–61.
Ballesta C, Poves I, Cabrera M, et al. Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients. Surg Endoscop. 2005;19:519–24.
Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:623–30.
Carrodeguas L, Szomstein S, Zundel N, et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis. 2006;2:92–7.
Goitein D, Papasavas PK, Gagné D, et al. Gastrojejunal strictures following Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2005;19:628–32.
Rossi TR, Dynda D, Estes NC, et al. Stricture dilation after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2005;189:357–60.
Ukleja A, Afonso BB, Pimentel R, et al. Outcome of endoscopic dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22:1746–50.
Conflicts of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Da Costa, M., Mata, A., Espinós, J. et al. Endoscopic Dilation of Gastrojejunal Anastomotic Strictures After Laparoscopic Gastric Bypass. Predictors of Initial Failure. OBES SURG 21, 36–41 (2011). https://doi.org/10.1007/s11695-010-0154-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-010-0154-7