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Updated: Jun 22, 2026

Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Management of transmesenteric tunnel jejunal strictures with endoscopic dilation by using achalasia balloons (with
Shou-jiang Tang1, David A Provost, Edward Livingston
1Department of Gastroenterology, Hepatology, and Endoscopy, Trinity Mother Frances Hospitals and Clinics, Tyler, Texas 75702, USA. sjtang2000@yahoo.com
Background:
Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Transmesenteric tunnel (TMT) or mesocolic jejunal stricture is an unusual postoperative complication that requires another operation. We hypothesize that endoscopic dilation by using achalasia dilatation balloons can be used to treat some TMT jejunal strictures.
Patients:
This study involved 6 consecutive cases of TMT stricture.
Intervention:
The TMT strictures were dilated by using achalasia balloons (30-40 mm) under fluoroscopic and endoscopic guidance.
Results:
With endotherapy, 4 patients with late onset of symptoms (>3 weeks after Roux-en-Y gastric bypass) have not required another operation to date, with a follow-up of at least 5 to 12 months. Two patients with early onset of symptoms (<3 weeks after surgery) required operations, and 1 of these patients (symptoms onset <7 days after surgery) developed jejunal perforation within the stricture during dilation due to underlying jejunal ischemia within the stricture.
Limitations:
Small case number and limited follow-up period.
Conclusion:
Endoscopic dilation by using achalasia balloons can be used to treat some TMT jejunal strictures without another operation. Surgery should be considered in patients with early onset of obstructive symptoms and/or with jejunal ischemia within the stricture.
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