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. 2022 Jun 24:35:e1665.
doi: 10.1590/0102-672020210002e1665. eCollection 2022.

GASTRIC TWIST AFTER SLEEVE GASTRECTOMY: A PROPOSAL FOR ENDOSCOPIC CLASSIFICATION

Luciana T Siqueira  1 , Fernando Santa-Cruz  2 , João Paulo Pontual  3 , Maria Amélia R Aquino  4 , Luca T Dompieri  4 , Flávio Kreimer  1 , Álvaro A B Ferraz  1
Affiliations

GASTRIC TWIST AFTER SLEEVE GASTRECTOMY: A PROPOSAL FOR ENDOSCOPIC CLASSIFICATION

Luciana T Siqueira et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Objective: The twisting of the gastric tube is one of the main causes of persistent reflux and food intolerance after sleeve gastrectomy (SG). To date, there is no classification for gastric twist after SG. This study aimed to propose an endoscopic classification for this condition and outline the clinical profile of these patients with sleeve gastrectomy.

Methods: Patients in the postoperative period of SG presenting endoscopic findings of gastric twist were included. All patients underwent an esophagogastroduodenoscopy 12 months after SG. The classification proposed consists of three degrees: degree I: mild rotation of the staple line without relevant shrinkage of the gastric lumen; degree II: moderate rotation of the staple line, leading to a focal area of fixed narrowing that requires additional maneuvers for its transposition; and degree III: severe rotation of the staple line leading to stenosis, with increased difficulty for transposition or complete blockage.

Results: Out of 2,723 patients who underwent SG, 45 (1.6%) presented gastric twist. Most patients were female (85%), with mean age of 39±10.4 years. In all, 41 (91.1%) presented degree I, 3 (6.7%) presented degree II, and 1 (2.2%) had degree III. Most patients were asymptomatic (n=26). Vomiting was the most prevalent symptom (15.5%). Statistically significant correlation of twisting degrees was not observed for both the presence of symptoms and the degrees of esophagitis.

Conclusion: Gastric twist after SG is rare, with generally mild and asymptomatic presentation. The endoscopic classification was not statistically related to clinical presentation but set the ground for further analysis.

A torção do tubo gástrico ou twist é uma das principais causas de refluxo persistente e intolerância alimentar após a gastrectomia vertical (GV). Até o momento, não há uma classificação proposta para a torção gástrica após GV.

OBJETIVO:: Propor uma classificação endoscópica para essa condição e descrever o perfil clínico desses pacientes.

MÉTODOS:: Pacientes no pós-operatório de GV apresentando achados endoscópicos de twist foram incluídos. Os pacientes foram submetidos a uma esofagogastroduodenoscopia 12 meses após a cirurgia. A classificação consiste em três graus. Grau I: rotação leve da linha de grampos, sem redução relevante do lúmen gástrico. Grau II: rotação moderada da linha de grampos, levando a uma área de estreitamento focal que requer manobras adicionais para a progressão do aparelho. Grau III: rotação severa da linha de grampos, levando à estenose, com grande dificuldade de progressão ou obstrução completa.

RESULTADOS:: Dos 2.723 pacientes que foram submetidos à GV, 45 (1,6%) apresentaram twist. A maioria dos pacientes era do sex feminino (85%), com idade média de 39±10.4 anos. Quarenta e um (91,1%) apresentaram twist grau I, 3 (6,7%) apresentaram twist grau II e apenas 1 (2,2%) apresentou twist grau III. A maioria dos pacientes eram assintomáticos (n=26). O sintoma mais prevalente foi vômito (15,5%). Não foi observada correlação estatisticamente significante entre o grau de twist e a presença de sintomas ou esofagite.

CONCLUSÃO:: Twist após GV é raro e geralmente assintomático. A classificação endoscópica proposta não foi estatisticamente relacionada com apresentação clínica, porém estabelece um referencial para análises futuras.

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Conflict of interest statement

Conflict of interest: None.

Figures

Figure 1 -
Figure 1 -. Perfectly symmetrical gastric sleeve, with no signs of twist.
Figure 2 -
Figure 2 -. Degree I: mild rotation of the staple line of the remnant stomach without relevant shrinkage of the gastric lumen.
Figure 3 -
Figure 3 -. Degree II gastric twist: moderate rotation of the staple line leading to a focal area of fixed narrowing that requires additional endoscopic maneuvers for its transposition.
Figure 4 -
Figure 4 -. Degree III: severe rotation of the staple line leading to stenosis, with increased difficulty for transposition or complete blockage.
See this image and copyright information in PMC

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References

    1. Abd Ellatif ME, Abbas A, El Nakeeb A, Magdy A, Salama AF, Bashah MM, Dawoud I, Gamal MA, Sargsyan D. Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy. Obes Surg. 2017;27(9):2404–2409. doi: 10.1007/s11695-017-2649-y. - DOI - PubMed
    1. Agnihotri A, Barola S, Hill C, Neto MG, Campos J, Singh VK, Schweitzer M, Khashab MA, Kumbhari V. An Algorithmic Approach to the Management of Gastric Stenosis Following Laparoscopic Sleeve Gastrectomy. Obes Surg. 2017;27(10):2628–2636. doi: 10.1007/s11695-017-2689-3. - DOI - PubMed
    1. Aminian A. Sleeve Gastrectomy: Metabolic Surgical Procedure of Choice? Trends Endocrinol Metab. 2018;29(8):531–534. doi: 10.1016/j.tem.2018.04.011. - DOI - PubMed
    1. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111(1):85–92. doi: 10.1053/gast.1996.v111.pm8698230. - DOI - PubMed
    1. Braghetto I, Korn O, Burgos A, Figueroa M. When should be converted laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass due to gastroesophageal reflux? Arq Bras Cir Dig. 2021;33(4):e1553. doi: 10.1590/0102-672020200004e1553. - DOI - PMC - PubMed