Endoscopic Management of Gastrojejunostomy Strictures: One Institution's Approach

Abstract

Patients with gastrojejunostomy strictures following Roux-en-Y gastric bypass can present with pain, nausea, dysphagia, and nutritional deficiencies. In our experience, most strictures can be treated with a combination of endoscopy and medical therapy, without the need for surgical revision. The ability to characterize the acuity of strictures as well as its morphology can guide subsequent therapy. Follow-up therapy after initial presentation is critical to avoid development of symptom chronicity, which can be the most difficult aspect to treat for both clinician and patient. Smoking and nonsteroidal anti-inflammatory use continue to be the main contributors of this condition. The management of these issues requires patience, astute follow-up, and a systematic approach, which has been outlined.