Endoscopic Treatment of Stomal Stenosis Following Roux-En-Y Gastric Bypass

摘要

Purpose: To determine the safety and effectiveness of endoscopic balloon dilation of stomal stenosis following gastric bypass. Methods: A retrospective review of 11 patients (10 women, 1 man; age 24-51, mean 36.5 years) who presented with synipt癿s of gastric outlet obstruction (nausea, vomiting, abdominal pain, and dietary intolerance) 4-37 weeks following gastric bypass surgery. All had experienced weight loss (14-42% body mass index reduction, mean 26%). Fndoscopic dilations were performed using 10-18 mm pyloric balloon at 105-135 PSI for 1 minute intervals. Dilations were repeated every 1-2 weeks for a total of 2-4 dilations if symptoms persisted. If symptoms improved prior to 2 dilations, patients were informed to follow-up as needed. Recurrent symptoms was defined as symptoms > 2 weeks after final dilation. Patients with co-existent stomal ulcerations were excluded from the study. Results: A total of 33 endoscopic procedures were performed. The average time from surgery to initial dilation was 15weeks (range 4-37). All patients had stomal stenosis ranging from 5-9 mm that did not allow advancement of the standard 8.9 mm gastroscope. The average number of dilations was 3 (range 1-5). The mean balloon size was 12 mm and the mean final balloon size was 16 mm. All patients were initially relieved of there gastric outlet obstruction. Four patients complained of recurrent symptoms 4-6 weeks later, subsequently relieved with one additional dilation. There were no complications. Conclusions: Endoscopic balloon dilation is an effective, non-surgical technique for the treatment of stomal stenosis with no complications observed in this small series.