Endoscopic balloon dilation for gastrojejunal anastomotic stricture after Roux‐en‐Y gastric bypass: A case series

Abstract

AbstractRoux‐en‐Y gastric bypass (RYGB) is an effective bariatric procedure but is encountered with gastrojejunal (GJ) anastomotic stricture as a major complication. We aimed to evaluate the efficacy and complications of endoscopic balloon dilation in the management of GJ anastomotic stricture after RYGB. Patients who underwent balloon dilation for GJ anastomotic stricture secondary to RYGB between March 2009 and April 2013 in E‐Da hospital were reviewed retrospectively. A smaller balloon size (8 mm) was routinely chosen initially and the balloon size was increased gradually. Dilation was stopped if the patients felt abdominal pain or up to 15 mm in size. Thirteen patients (nine men and four women) with a median age of 26 years (range 20‐42 years) and a median body mass index of 41.5 kg/m2 (range 35.3‐65.4 kg/m2) were enrolled. Anastomotic size ranged from 1 to 4 mm. The median interval between surgery and the first dilation was 43 days (range 20‐112 days). Nine patients (69.2%) required only one dilation, three (23.1%) required two dilations, and one (7.7%) required three dilations. Seven patients (53.8%) had anastomotic ulcers. Two patients had perforation and were treated conservatively. Twelve patients (92.3%) were successfully treated by balloon dilation. One patient was found to have a total obstruction 4 months after the first dilation and underwent operation. This study suggests that endoscopic balloon dilation is effective in the management of GJ anastomotic stricture after RYGB and most of the patients responded to one dilation session. Although perforation occurred, it can be treated conservatively in our case series.