Modified gastric peroral endoscopic myotomy for helical stenosis after sleeve gastrectomy

Gastric sleeve stenosis (GSS) occurs in 0.7% to 4% of cases after laparoscopic sleeve gastrectomy and can lead to leaks, fistulas, refractory reflux, regurgitation, and diet intolerance. It is classified into 2 subtypes: helical and nonhelical. Although stent placement and pneumatic dilation may help with nonhelical stenosis, they often do not produce sufficient results for helical stenosis. Recently, a modified gastric peroral endoscopic myotomy (G-POEM) technique (tunneling stricturotomy) has been introduced as a salvage treatment for GSS.

In this case series, we present 3 cases of patients with helical sleeve stenosis treated with modified G-POEM as the initial approach. All patients in this series underwent under-saline solution tunneling, which helped navigate a swirling, challenging submucosal space. The article offers techniques and tips for successfully completing the procedure.

The procedure was successfully performed in all patients, who experienced significant clinical improvement and were able to tolerate a low-residue diet. No adverse events were reported.

Although our case series demonstrates that tunneling stricturotomy was safe and effective as a primary treatment for gastric sleeve helical stenosis, additional data are needed to evaluate its safety and long-term effectiveness compared with other endoscopic treatments.