Endoscopic balloon dilation of anastomotic strictures occurring after laparoscopic gastric bypass for morbid obesity

Abstract

Background: Gastrojejunal anastomotic stenosis of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity occurs in 3-25% of cases. The aim of this report was to evaluate the utility of endoscopic balloon dilation for the therapy of anastomotic strictures after LRYGB.

Patients and methods: 111 consecutive patients were treated with endoscopic dilation under sedation with propofol. Dilations were performed with through-the-scope over-the-wire balloons, with sizes ranging from 6 to 18 mm. The outcomes of the procedure were analyzed.

Results: 200 endoscopic balloon dilations were performed in 111 patients. Repeated dilations were necessary in patients with complex stenosis. In 75% of the patients it was possible to dilate to 12 mm during the first session. Only in 2% of the cases was it impossible to introduce the endoscope through the stenosed anastomosis after dilation. On follow-up a repeat dilation was necessary in 26% of the cases. Minor complications occurred in 2.7% of patients (2 concealed perforations and 1 hematoma of the esophagus). These were treated conservatively. None of the patients required operation.

Conclusions: Endoscopic balloon dilation is a safe and effective therapy for anastomotic strictures occurring after LRYGB.