Role of Endoscopic Stent Insertion on Management of Gastric Twist after Sleeve Gastrectomy

The effectiveness of endoscopic management of twisting of the gastric pouch after sleeve gastrectomy.

This was a retrospective study on Ain Shams University Hospital. Patients who had obstructive symptoms and diagnosed with twist after gastric sleeve were included in this study.

From May 2017 to January 2019, 860 patients underwent LSG as a definitive procedure. Thirty-two (3.7%) patients developed symptoms of gastric obstruction. Twenty-two (2.5%) patients diagnosed with sleeve axial twist were included in this study after excluding 11 patients with sleeve stricture. A total of 72% (16 out of 22) of patients were female, with a mean age of 41. The mean time of presentation was 40 days (20-60 days) after surgery. Gastrografin contrast study was positive in 14 (63%) patients. 3D contrast CT was positive in 100% of cases. The timing of endoscopic intervention was 40 ± 20 days (20-60) after surgery. Endoscopic treatment was successful in 20 patients (91%). Recovery was uneventful in 19 patients; 1 patient had esophageal stricture at the upper end of the stent, which necessitated a session of dilation. The success of endoscopic intervention was 91% with complete relief of symptoms and correction of the gastric pouch axis. Endoscopic intervention failed in only 2 patients (9%) who necessitated laparoscopic exploration after stent removal.

Gastric pouch twisting is a rare complication; however, it has a rising incidence. Endoscopic stent insertion is highly effective on the management of twisting after SG and it should be tried before any further surgical intervention.