Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass

doi:10.1016/j.gie.2006.10.012

Gastrointestinal Endoscopy

Volume 66, Issue 2, August 2007, Pages 248-252

https://doi.org/10.1016/j.gie.2006.10.012 Get rights and content

Background

Roux-en-Y gastric bypass is the most frequently performed bariatric surgery for morbid obesity. Gastrojejunal anastomotic strictures are a relatively frequent postoperative complication.

Objective

To evaluate the clinical outcomes and therapeutic response to through-the-scope balloon dilation performed to treat anastomotic strictures after Roux-en-Y gastric bypass surgery.

Design

Single-center, retrospective study.

Setting

Academic medical center.

Patients

Between 1997 and 2005, 801 patients with morbid obesity underwent Roux-en-Y gastric bypass surgery at our institution.

Main Outcome Measurements

The development of an anastomotic stricture after Roux-en-Y gastric bypass surgery. The response to through-the-scope balloon dilation after diagnosis.

Results

Forty-three of 801 patients (5.4%) developed an anastomotic stricture (26 of 294 open surgeries [8.8%]; 17 of 507 laparoscopic surgeries [3.4%]; P < .001). Strictures were dilated to 15.5 ± 0.4 mm. There were no perforations or clinically significant bleeding after dilation; 93% of the strictures were successfully managed with 1 or 2 endoscopic sessions. Dilation to at least 15 mm did not affect weight loss at 1 year when compared with the group without a stricture (percentage excess weight loss: stricture group, 76%; no stricture group, 74%).

Limitations

Single-center, retrospective study.

Conclusions

Endoscopic balloon dilation is a safe and effective method for the management of gastrojejunostomy strictures after Roux-en-Y gastric bypass. Dilation to at least 15 mm is safe and decreases the need for further endoscopic dilation.

Section snippets

Patients and methods

A retrospective review was performed on prospectively collected data on all RYGBP procedures performed at a single institution from July 1997 to August 2005. Institutional review board approval was obtained before initiation of this retrospective study. Both open and laparoscopic procedures were included in the analysis. In all cases, the jejunum was divided 30 cm distal to the ligament of Treitz. The standard length of the Roux limb was 75 cm. Patients with a BMI >50 received a 150-cm Roux

Results

Gastric bypass was performed on 801 patients (open RYGBP in 294 patients, laparoscopic RYGBP in 507 patients). The mean preoperative BMI was 55.1 kg/m². The mean age at surgery was 44.5 years, and 81% of the patients were women. Baseline patient characteristics and weight loss in the first year are shown in Table 1. The excess weight loss and BMI at 1 year fell within the range considered to be a good result.

Gastrojejunal anastomotic stricture developed in 43 of 801 patients (5.4%) (Table 2).

Discussion

Morbid obesity is reaching epidemic proportions in many westernized countries. Medical therapies have been largely unsuccessful in maintaining significant sustained weight loss. Surgery for morbid obesity is currently the only proven option for long-term weight loss. Consequently, the number of bariatric surgeries and resulting complications are likely to increase. Gastrojejunal anastomotic strictures remain a relatively frequent complication, occurring in up to 16% in some studies.5, 10, 11, 14

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: Presented at Digestive Disease Week, New Orleans, Louisiana, May 15-20, 2004 (Gastroenterology 2004;126:A-806).

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Original Article: Clinical EndoscopySuccessful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass

Background

Objective

Design

Setting

Patients

Main Outcome Measurements

Results

Limitations

Conclusions

Section snippets

Patients and methods

Results

Discussion

J Gastrointest Surg

The continuing epidemics of obesity and diabetes in the United States

JAMA

Body-mass index and mortality in a prospective cohort of U.S. adults

N Engl J Med

What is the economic case for treating obesity?

Obesity Res

Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians

Ann Intern Med

Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs

Ann Surg

Laparoscopic vertical banded gastroplasty and Roux-en-Y gastric bypass in morbid obesity

Obes Surg

Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned?

Obes Surg

Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity

Ann Surg

Original Article: Clinical Endoscopy
Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass