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. 2016 Dec 21;22(47):10371-10379.
doi: 10.3748/wjg.v22.i47.10371.

Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

Anand Nath  1 , Sayali Yewale  1 , Tung Tran  1 , John S Brebbia  1 , Timothy R Shope  1 , Timothy R Koch  1
Affiliations

Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

Anand Nath et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG).

Methods: VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.

Results: Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.

Conclusion: Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

Keywords: Bariatric surgery; Dysphagia; Obesity; Stomach dilatation; Vertical sleeve gastrectomy.

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Conflict of interest statement

Conflict-of-interest statement: All of the authors have no conflict of interest to report regarding the publication of this paper.

Figures

Figure 1
Figure 1
Response of study subjects with narrowing of the gastric sleeve after vertical sleeve gastrectomy. This figure shows the number of individuals (on the Y axis) who underwent one, two or three or more dilatations (on the X axis) of their gastric sleeve and then obtained full, partial, or no resolution of their symptom of dysphagia.
See this image and copyright information in PMC

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