Endoscopic management of gastric outlet obstruction following surgery for morbid obesity

Surgery of morbid obesity is associated with significant morbidity, which is considerably increased for reoperative surgery. Over the past two and a half years endoscopic balloon dilation was performed in eight patients for stenosis of gastrojejunostomy following gastric bypass. The technique of dilation, indications, and pitfalls are discussed. The procedure was safe and effective. Patients who had dilation performed successfully avoided surgery entirely in seven of eight cases. Therapy was modified in two other patients based on endoscopy findings. Endoscopy was found to be more reliable and superior to upper gastrointestinal (UGI) series for evaluation of symptoms following gastric bypass procedures. Based on our experience and literature review we propose that endoscopy is the preferred alternative to major reoperative surgery and urge its wider use.