Bariatric surgery has become a common treatment for obesity. Although effective, complications may arise as a result of surgery. These include strictures, which can be present in up to 20% of cases. While treatment for endoscopic strictures relies on balloon dilation, the clinical and endoscopic factors for failure and revision surgery requirement are scarcely described in the literature. We evaluated the predictors for need of revision surgery on patients undergoing balloon dilation for bariatric surgery stricture. This is a two-center retrospective study of patients who presented with a bariatric surgery related stricture and underwent balloon dilation treatment between 2000-2018 at Cleveland Cleveland System. Demographic data, type of bariatric surgery and associated characteristics, post-bariatric complications, comorbidities, time to symptom presentation, symptoms at diagnosis, endoscopic findings, number of procedures, and need for revision surgery variables were collected. Patients included were >17 years with previous bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass). Subjects were excluded if pregnant or underwent treatment with a different modality than balloon dilation. Univariate analysis was used to compare the characteristics between subjects with successful dilation and subjects requiring revision surgery after failed dilation. Multivariate logistic regression with backward elimination was used to determine odds ratio (OR) for factors associated to dilation failure. A total of 94 patients met the inclusion criteria. The cohort consisted of 10.6% males, with mean age 52.4 years at stricture presentation, and predominantly white (81.9%). The majority of patients underwent Roux-en-Y gastric bypass (86.2%). Mean time from surgery to stricture presentation was 59.9 months, with most presenting vomiting (61.7%). Hospitalization for stricture was required in 92.6%. Mean initial stricture size was 6.5 mm, with max balloon dilation of 13.5 mm, and complete stricture resolution with first EGD in 15.9% of cases. A mean of 3.6 EGDs were required in patients requiring repeat dilations, with max dilation of 15.8 mm. Revision surgery was performed in 20 patients (21.3%) due to treatment failure. Other demographic, clinical and endoscopic features are listed in Table 1. Univariate analysis showed race (p=0.019) and anastomotic ulcers in EGD (p=0.018) were predictors of dilation failure. Multivariate analysis showed marginal ulcers were associated with a high risk of dilation failure (OR 3.09, p=0.03) (Table 2). Bariatric strictures are common in patients undergoing weight-loss procedures. While patients may respond to single dilation, most patients require several dilations to achieve symptom resolution. The presence of marginal ulcers upon initial EGD is a poor response predictor and higher likelihood for revision surgery need.Table 2Univariate/multivariate comparison of characteristics between patients with successful and unsuccessful dilation treatments.View Large Image Figure ViewerDownload Hi-res image Download (PPT)