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Gastric Stenosis After Sleeve Gastrectomy: an Algorithm for Management
Hosam Hamed1, Hosam Elghadban2, Helmy Ezzat3
1Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt. Hosam-eldin@hotmail.com.
Obesity Surgery
|July 20, 2020
Summary
Pneumatic balloon dilatation (PBD) is effective for managing gastric stenosis (GS) after sleeve gastrectomy (SG). Revisional surgery like RYGB offers high success for refractory cases, guiding a new management algorithm.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical Complications
Background:
- Gastric stenosis (GS) is a significant complication post-sleeve gastrectomy (SG), impacting patient well-being.
- Current management strategies for GS lack a standardized, comprehensive algorithm.
- Obstructive gastric symptoms (OGSs) following SG necessitate effective treatment protocols.
Purpose of the Study:
- To evaluate treatment modalities for obstructive gastric symptoms (OGSs) after sleeve gastrectomy (SG).
- To propose a validated management algorithm for post-sleeve gastrectomy gastric stenosis (GS).
Main Methods:
- Retrospective cohort study of patients with GS post-SG (January 2013 - January 2019).
- Exclusion of patients with concomitant GS and staple-line leak.
- Primary outcome assessed: clinical response to treatment interventions.
Main Results:
- Pneumatic balloon dilatation (PBD) achieved 66.7% success in 42 patients with evident GS.
- Empirical PBD improved four of six patients with indolent GS.
- Endoscopic stenting and revisional surgery (RYGB) were successful in all patients after failed PBD.
Conclusions:
- Pneumatic balloon dilatation (PBD) is the primary treatment for GS post-SG.
- Endoscopic stenting requires specific considerations for GS management.
- Roux-en-Y gastric bypass (RYGB) is the preferred revisional surgery for refractory GS.
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