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Erschienen in: Obesity Surgery 10/2017

03.05.2017 | Original Contributions

An Algorithmic Approach to the Management of Gastric Stenosis Following Laparoscopic Sleeve Gastrectomy

verfasst von: Abhishek Agnihotri, Sindhu Barola, Christine Hill, Manoel Galvao Neto, Josemberg Campos, Vikesh K Singh, Michael Schweitzer, Mouen A Khashab, Vivek Kumbhari

Erschienen in: Obesity Surgery | Ausgabe 10/2017

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Abstract

Background

Gastric stenosis (GS) is a potential adverse event post-laparoscopic sleeve gastrectomy (LSG). Endoscopic management is preferred; however, there is significant variation in therapeutic strategies with no defined algorithm. This study aims to describe the safety and efficacy of a predefined step-wise algorithm for endoscopic management of GS post-LSG.

Methods

Consecutive patients with symptomatic GS post-LSG, presenting between July 2015 and August 2016, were subjected to a predefined treatment algorithm of serial dilations using achalasia balloons, followed by a fully covered self-expanding metal stent (FCSEMS) if dilations were inadequate. Patients who did not respond or opted out of ongoing endoscopic therapy were offered revision Roux-en-Y gastric bypass (RYGB).

Results

Total of 17 patients underwent a median of 2 (range 1–4) balloon dilations. Twelve patients (70.6%) reported clinical improvement with balloon dilation alone, while 3 (17.6%) required subsequent FCSEMS placement. One patient suffered a tear to the muscularis propria with balloon dilation, which was managed conservatively. Overall, 15 (88.2%) reported clinical improvement with endoscopic management. PAGI-SYM scores revealed that the strongest response to therapy, based on mean reduction of score ± SD, was in the following items: nausea (3 ± 1.9, P < 0.001), heartburn during day (2.8 ± 1.5, P = 0.003), heartburn on lying down (3.4 ± 1.4, P < 0.001), reflux during day (2.8 ± 1.9, P < 0.001), and reflux on lying down (3.0 ± 1.9, P < 0.001). Two (11.8%) patients failed endoscopic therapy and underwent RYGB.

Conclusions

Endoscopic management of GS using the described algorithmic approach is safe and effective post-LSG. Patients with severe stenosis or helical stenosis are likely to require revision RYGB.
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Metadaten
Titel
An Algorithmic Approach to the Management of Gastric Stenosis Following Laparoscopic Sleeve Gastrectomy
verfasst von
Abhishek Agnihotri
Sindhu Barola
Christine Hill
Manoel Galvao Neto
Josemberg Campos
Vikesh K Singh
Michael Schweitzer
Mouen A Khashab
Vivek Kumbhari
Publikationsdatum
03.05.2017
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 10/2017
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2689-3

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