Abstract
Obesity has reached epidemic proportions in the US with significant impact on pt health. Many therapies have been unsuccessful. Surgery appears to be the only effective long-term solution. Roux-en-Y bypass (RYGB), takes advantage of both restrictive (small pouch) & malabsorptive technique (bypass). An occasional problem with restrictive procedures is postoperative stenosis of the gastric outlet (stoma) causing variable obstructive symptoms. Methods: Over 4-yrs, 29 RYGB pts with symptoms of gastric outlet obstruction presented for endotherapy. 23 F/6 M, age 28-45 (mean 37.5). Pt presentation: rapid wt loss (24), N/V (28), dehydration (5), & dysphagia (2). Pts presented 1-18 mo following RYGB (mean 4). All procedures were done with standard upper scope under fluoro. Dilation was performed using graduated CRE balloons (8-10, 10-12, 12-15) to maximum diameter (8 atm), 60 sec intervals. One CRE balloon sz range was used per endo session. Following dilation, the stoma was injected with a steroid solution (Kenalog 40 mg, mixture 1:4), 1 cc/quadrant, circumferentially. Results: All underwent successful balloon dil. Dilating sessions ranged from 1-7 (mean 2.4) at 2-wk intervals. This included 8 pts-one dil, 10 pts-two dil, 7 pts-3 dil, 3 pts-4 dil, 1 pt-7 dil. Those pts requiring repeat dil (21) underwent repeat maximum dil with 8-10 CRE (4), 10-12 CRE (11), & 12-15 CRE (7). Need for repeat dil was determined by persistence of initial symptoms, & stoma sz <10 mm at F/U. Estimated stoma diameter prior to dil was 1-8 mm (mean 3.5). None could be traversed with standard scope. Following dil, diameter of stoma increased to 10-15 mm (mean 12.5). Of pts who required a single dil (8), pre dil stoma sz was a mean of 5.6 mm (range 3-8), which increased to a mean of 12.7 mm (range 10-15). Those requiring multiple dil (21), pre dil stoma sz was a mean of 2.6 mm (range 1-4), which increased to a mean of 12.1 mm (range 10-14). 28 of 29 pts had good long-term response at 6-38 mo. One pt with concomitant large stomal ulcer required surgical revision following 7 dil sessions. All pts had resumption of wt loss expected for RYGB following successful endotherapy. Conclusions: Stomal stenosis following RYGB is a common post surgical complication. Endoscopic balloon dil is an effective, nonsurgical option in the treatment of stomal stenosis with no complications observed in this, the largest reported series. Tabled 1 Stoma Diameter-mm(mean) Frequency of Dilation Pt (n) Pre Dilation (mean) Post Dilation (mean) Single 8 5.6 12.7 Multiple 21 2.6 12.1 Total 29 3.5 12.2 Open table in a new tab
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call