Surgeon-performed endoscopic dilatation of symptomatic gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass

Abstract

Background: With increasing performance of Roux-en-Y gastric bypass (RYGBP), the postoperative complications are becoming more apparent. Gastrojejunal anastomotic strictures develop in 4.7 to 27% of patients undergoing laparoscopic RYGBP. This paper details two endoscopic techniques for dilating gastrojejunal anastomotic strictures.

Methods: 3 patients developed gastrojejunal anastomotic strictures. In each patient, the operating surgeon performed a diagnostic upper endoscopy, followed by stricture dilatation using either Savary or balloon method.

Results: Patients lost a mean weight of 42 kg (range 33-50 kg) before definitive stricture treatment. Once adequately dilated, all patients received an excellent symptomatic result.

Conclusions: For the treatment of gastrojejunal anastomotic strictures, both Savary and balloon dilatation have been efficacious and easy to perform. The endpoint for stricture dilatation is 12 mm or slightly larger. The operating surgeon should acquire a working knowledge of these techniques.