Evaluation of the excluded stomach by double-balloon endoscopy after laparoscopic Roux-en-Y gastric bypass

Abstract

Morbid obesity has become a serious health problem. We have been performing laparoscopic Roux-en-Y gastric bypass (LRYGBP) for morbid obesity since February 2002. Although LRYGBP ameliorates complications of morbid obesity, postoperative investigation of the excluded stomach is difficult. In patients with a family history of gastric cancer, resection of the bypassed stomach is sometimes added, but this requires longer operating time. There are two problems associated with LRYGBP: the high rate of gastric cancer in Japan, and how to investigate the excluded stomach. To resolve these problems, we introduced double-balloon intestinal endoscopy. We report double-balloon endoscopy (DBE) in 4 patients. No problems with advancing the endoscope were encountered during observation. We used an overtube to insert the scope further in order to avoid forming redundant loops in the small intestine, and two balloons to grip the intestinal wall. Although performing DBE involves a learning curve, there were no major obstacles to passage of the scope into the esophagus, small gastric pouch, lifted jejunum, the jejunojejunal anastomosis, Y-loop, duodenum and excluded stomach. Use of the double-balloon technique makes it possible to observe the GI tract after laparoscopic LRYGBP irrespective of the length between the gastrojejunostomy and the jejunojejunostomy.