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Evans G, Yu JX, Moy B, Leith A, Volk S, Taher O, Miller C, Schulman AR. Use of Impedance Planimetry in the Diagnosis of Gastric Sleeve Stenosis: The Establishment of New Benchmark Values. Am J Gastroenterol 2024; 119:1074-1080. [PMID: 38131629 DOI: 10.14309/ajg.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Gastric sleeve stenosis (GSS) is an increasingly common adverse event following sleeve gastrectomy for which objective diagnostic criteria are lacking. Impedance planimetry measurements show promise in characterizing GSS, though normal and abnormal benchmark values have never been established. METHODS This was a retrospective analysis of upper endoscopies performed with impedance planimetry for suspected GSS. A bariatric endoscopist, blind to impedance planimetry measurements, assessed gastric sleeve anatomy and graded GSS severity. Impedance planimetry of diameter and distensibility index (DI) were obtained using 3 different balloon volumes (30, 40, and 50 mL). RESULTS A total of 110 upper endoscopies were included. Distribution of GSS was graded as none, mild, moderate, and severe in 19 (17%), 27 (25%), 34 (31%), and 30 (27%) procedures, respectively. In normal gastric sleeve anatomy, mean (±SD) diameter and DI measurements using consecutive balloon volumes ranged from 19.1 (±5.5) to 23.2 (±1.7) and 16.8 (±4.9) to 23.1 (±10.9), respectively. In severe GSS, mean diameter and DI measurements ranged from 10.3 (±3.0) to 16.6 (±2.1) and 7.5 (±2.4) to 7.7 (±2.4), respectively. When stratified by severity, impedance planimetry measurements of diameter and DI were significantly lower with each subsequent increase in GSS grade regardless of balloon fill volumes ( P ≤ 0.001). DISCUSSION Impedance planimetry measurements provide objective assessment in the diagnosis of GSS and correlate with luminal narrowing. A diameter ≥20 mm and a DI ≥15 mm 2 /mm Hg, as measured by impedance planimetry, are predictive of normal gastric sleeve anatomy. This study provides new benchmark values for the diagnosis and severity of GSS.
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Affiliation(s)
- Gretchen Evans
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica X Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin Moy
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Annelie Leith
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah Volk
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Omar Taher
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Candice Miller
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Elsebaey MA, Enaba ME, Elashry H, Elrefaey W, Hagag RY, Shalaby NA, Aboelnasr MS, Sarhan ME, Darrag OM, Elsokkary AM, Alabd MAA, El Nakib AM, Abdulrahim AO, Abo-Amer YEE, Mahfouz MS, Fouad AM, Abd El latif RS, Allam KA, Ismail AAM. The Efficacy and Safety of Endoscopic Balloon Dilatation in the Treatment of Functional Post-Sleeve-Gastrectomy Stenosis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:833. [PMID: 38793016 PMCID: PMC11123478 DOI: 10.3390/medicina60050833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/23/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. Patients and Methods: Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. Results: A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients' clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. Conclusions: Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.
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Affiliation(s)
- Mohamed A. Elsebaey
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Mohamed Elsayed Enaba
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Heba Elashry
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
| | - Waleed Elrefaey
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Rasha Youssef Hagag
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Neveen A. Shalaby
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Mohamed Sabry Aboelnasr
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Mohamed Elsayed Sarhan
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | - Omneya Mohamed Darrag
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt; (M.A.E.); (M.E.E.); (W.E.); (R.Y.H.); (M.S.A.); (M.E.S.)
| | | | - Mohamed Abd Allah Alabd
- Gastroenterology, Hepatology and Infectious Diseases Department, Red Crescent Hospital, Tanta 66232, Egypt
| | - Ahmed Mohamed El Nakib
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | | | - Yousry Esam-Eldin Abo-Amer
- Hepatology, Gastroenterology and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, El-Mahalla el-Kubra 31951, Egypt
| | - Mohammad Shaaban Mahfouz
- Hepatology, Gastroenterology and Infectious Diseases Department, Ahmed Maher Teaching Hospital, Cairo 11638, Egypt;
| | - Amina Mahmoud Fouad
- Clinical Pathology Department, National Hepatology and Tropical Medicine Research Institute, Cairo 42600, Egypt
| | - Raghda Samir Abd El latif
- Clinical Pathology Department, National Hepatology and Tropical Medicine Research Institute, Cairo 42600, Egypt
| | - Khaled Asem Allam
- General Surgery Department, Ahmed Maher Teaching Hospital, Cairo 11638, Egypt
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Yu JX, Evans G, Volk S, Watts L, Schulman AR. Endoscopic severity of gastric sleeve stenosis can be quantified using impedance planimetry. Surg Endosc 2023:10.1007/s00464-023-10077-y. [PMID: 37081245 DOI: 10.1007/s00464-023-10077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Gastric sleeve stenosis (GSS) is an adverse event following sleeve gastrectomy for which objective tools are needed for diagnosis and treatment. Endoscopic treatment with serial pneumatic balloon dilation may relieve symptoms and prevent the need for conversion to Roux-en-Y gastric bypass. Endoluminal functional impedance planimetry (EndoFLIP) is an endoscopic tool that measures luminal diameter and distensibility indices (DI) and could be used to characterize severity of GSS. METHODS This was a retrospective analysis of a prospective database of patients referred for symptoms suggestive of GSS. Severity was determined at each endoscopy by a bariatric endoscopist blinded to EndoFLIP measurements. Successive pneumatic balloon dilations were performed until symptoms resolved; failure was defined as referral for conversion. EndoFLIP measurements of stenosis diameter and DI were obtained pre- and post-dilation. Primary outcomes were pre- and post-dilation luminal diameter and DI of GSS. Secondary outcomes were endoscopic severity of GSS, patient characteristics, and need for surgical revision. RESULTS 26 patients were included; 23 (85%) were female. Mean age was 45.3 (± 9.9) years. Mean number of dilations was 2.4 (± 1.3) and 10 (38%) patients were referred for conversion. Mild, moderate, and severe GSS was found in 10 (38%), 6 (23%), and 10 (38%) patients, respectively. Moderate and severe GSS underwent more dilations (2.5 ± 1.0 and 3.2 ± 1.6) than mild GSS (1.8 ± 0.8) and were more likely to be referred for conversion. Both pre- and post-dilation diameters were significantly larger in mild versus moderate or severe GSS. Additionally, pre- and post-dilation DI at 30 ml were significantly higher for mild compared to moderate and severe GSS. DISCUSSION EndoFLIP measurements correlate well with endoscopic assessment of GSS. While more data are needed to determine ideal balloon size and threshold measurements, our results suggest EndoFLIP may help expedite diagnosis and treatment of GSS.
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Affiliation(s)
- Jessica X Yu
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Dr., 3912 Taubman Center, Ann Arbor, MI, 48109-5362, USA
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA
| | - Gretchen Evans
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Dr., 3912 Taubman Center, Ann Arbor, MI, 48109-5362, USA
| | - Sarah Volk
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Dr., 3912 Taubman Center, Ann Arbor, MI, 48109-5362, USA
| | - Lydia Watts
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Dr., 3912 Taubman Center, Ann Arbor, MI, 48109-5362, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Dr., 3912 Taubman Center, Ann Arbor, MI, 48109-5362, USA.
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Pneumatic Balloon Dilation of Gastric Sleeve Stenosis Is Not Associated with Weight Regain. Obes Surg 2022; 32:1-6. [PMID: 35380359 DOI: 10.1007/s11695-022-05957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gastric sleeve stenosis (GSS) occurs in up to 4% of patients after laparoscopic sleeve gastrectomy (LSG). Typical symptoms include reflux, abdominal pain, dysphagia, and regurgitation. Serial pneumatic balloon dilation (PBD) is a successful treatment in many cases obviating the need for revisional surgery, but the potential for weight regain is unknown. The aim of the current study was to assess weight trends following serial pneumatic dilation for GSS. METHODS Retrospective analysis of a prospectively maintained database of patients undergoing serial PBD for GSS at one institution. Primary outcome was change in BMI before and after serial PBD. Secondary outcomes included complication rates and need for revisional surgery. Sub-group analyses were performed to determine the relationship of patient and procedural factors to BMI after PBD. RESULTS Forty-four patients met inclusion criteria, 34 (84.1%) women. Mean age was 46.7 (SD 11.9). Mean pre-sleeve BMI was 47.8 (SD 9.2), and mean BMI prior to first dilation was 34.2 (SD 6.8). Median follow-up was 395 days (range 48-571). Mean BMI at time of last follow up was 33.7 (SD 6.7). There was no statistical difference in BMI pre- or post-PBD (p 0.980). The lowest 10th and highest 90th BMI percentile trended toward a higher and lower BMI after PBD, respectively, though not significant. DISCUSSION As the prevalence of sleeve gastrectomy continues to rise, an increasing number of patients will require treatment for GSS. Stenosis is effectively treated with serial PBD in most patients without any impact on weight gain, making this an effective and appealing option for many patients.
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Lorenzo D, Gkolfakis P, Lemmers A, Louis H, Huberty V, Blero D, Devière J. Endoscopic Dilation of Post-Sleeve Gastrectomy Stenosis: Long-Term Efficacy and Safety Results. Obes Surg 2021; 31:2188-2196. [PMID: 33598846 DOI: 10.1007/s11695-021-05252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Post-sleeve gastrectomy (SG) stenoses occur in about 5% of cases. Hydrostatic dilation (HD) and pneumatic dilation (PD) have been proposed as treatments, but efficacy data remain scarce. Objective is to describe long-term efficacy and safety of HD and PD. METHODS This retrospective study in a referral endoscopy center included patients with symptomatic post-SG stenosis treated with endoscopic balloon dilation (EBD). Stenosis was defined as "organic" if luminal narrowing was evident, "functional" for a deformation, or "combined." Endoscopic treatment consisted of ≥ 1 HD (15-20 mm) and/or ≥ 1 PD (30-35 mm). Initial success was defined as improvement of stenosis-related symptoms at 1 month and long-term success as persistence of improvement at last follow-up. RESULTS Forty-four patients (73% women; mean age 45.5 ± 11 years; mean follow-up 26 ± 23 months) underwent EBD between 2013 and 2019. HD and PD were used in 15 (34%) and 29 (66%) patients, respectively, (mean dilation number: 1.8 ± 1.1). Post-SG stenoses were considered organic in 10 (23%), functional in 21 (48%), and combined in 13 (29%) patients. Initial success was achieved in 42 (96%) patients, while 35 (80%) patients had no symptom recurrence at last follow-up. Perforation occurred in one patient. HD was more frequently used in organic stenoses (8/10), while PD in functional and combined stenoses (18/21 and 9/13, respectively; p < 0.001). Rates of success did not differ by type of stenosis. CONCLUSION Endoscopic dilation is an effective treatment for post-SG stenoses, providing long-term symptom relief. PD should be preferred in cases of functional stenoses, and HD used for organic stenoses.
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Affiliation(s)
- Diane Lorenzo
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hubert Louis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Daniel Blero
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Hany M, Ibrahim M, Zidan A, Samir M, Elsherif A, Selema M, Sharaan M, Elhashash M. Role of Primary Use of Mega Stents Alone and Combined with Other Endoscopic Procedures for Early Leak and Stenosis After Bariatric Surgery, Single-Institution Experience. Obes Surg 2021; 31:2050-2061. [PMID: 33409972 DOI: 10.1007/s11695-020-05211-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Surgical therapy for post-bariatric surgery complications is associated with significant morbidity and mortality. Endoscopic options like primarily endoscopically placed fully covered self-expandable metallic stents (SEMS) offer significant benefits for the management of leaks and obstructions or stenosis, and even in case of mega stent failure, further endoscopic techniques could resolve the situation. MATERIALS AND METHODS We conducted a single-centre retrospective study on patients with leakage and stenosis/obstruction after bariatric surgery who were managed primarily by SEMS between January 2015 and January 2019. Clinical success rate was evaluated in terms of the cure of the reason for stenting, the need for other interventions, and the presentation of stent-related complications. RESULTS There were 58 patients included, (50 with leak, 8 with stenosis/obstruction following bariatric surgery). Mean time to stent placement was 6.82 (±1.64) days for the leak group and 35 (±21.13) days for the stenosis group (p = 0.019). Successful outcomes with SEMS alone were achieved in 42 (72.41%) patients, while 16 patients had failed SEMS treatment, of whom 14 were successfully managed by endoscopic procedures while two cases needed surgical intervention. Of the SEMS-related complications encountered, 25.86% were ulcers; 24.13%, vomiting; 22.41%, gastroesophageal reflux disease (GerdQ≥8); 18.96%, stent migration; and 5.17%, stent intolerance. CONCLUSION A mega stent is an effective and safe tool for the early management of post-bariatric surgery leakage and stenosis, and it is associated with acceptable rates of failure that can be managed by further endoscopic techniques in most of the patients.
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Affiliation(s)
- Mohamed Hany
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
| | - Mohamed Ibrahim
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ahmed Zidan
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Samir
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Amr Elsherif
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Selema
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Sharaan
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Elhashash
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
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A protocolized approach to endoscopic hydrostatic versus pneumatic balloon dilation therapy for gastric sleeve stenosis: a multicenter study and meta-analysis. Surg Obes Relat Dis 2020; 16:1543-1553. [DOI: 10.1016/j.soard.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022]
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Endoscopic devices and techniques for the management of bariatric surgical adverse events (with videos). Gastrointest Endosc 2020; 92:492-507. [PMID: 32800313 DOI: 10.1016/j.gie.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS As the prevalence of obesity continues to rise, increasing numbers of patients undergo bariatric surgery. Management of adverse events of bariatric surgery may be challenging and often requires a multidisciplinary approach. Endoscopic intervention is often the first line of therapy for management of these adverse events. This document reviews technologies and techniques used for endoscopic management of adverse events of bariatric surgery, organized by surgery type. METHODS The MEDLINE database was searched through May 2018 for articles related to endoscopic management of adverse events of bariatric interventions by using relevant keywords such as adverse events related to "gastric bypass," "sleeve gastrectomy," "laparoscopic adjustable banding," and "vertical banded sleeve gastroplasty," in addition to "endoscopic treatment" and "endoscopic management," among others. Available data regarding efficacy, safety, and financial considerations are summarized. RESULTS Common adverse events of bariatric surgery include anastomotic ulcers, luminal stenoses, fistulae/leaks, and inadequate initial weight loss or weight regain. Devices used for endoscopic management of bariatric surgical adverse events include balloon dilators (hydrostatic, pneumatic), mechanical closure devices (clips, endoscopic suturing system, endoscopic plication platform), luminal stents (covered esophageal stents, lumen-apposing metal stents, plastic stents), and thermal therapy (argon plasma coagulation, needle-knives), among others. Available data, composed mainly of case series and retrospective cohort studies, support the primary role of endoscopic management. Multiple procedures and techniques are often required to achieve clinical success, and existing management algorithms are evolving. CONCLUSIONS Endoscopy is a less invasive alternative for management of adverse events of bariatric surgery and for revisional procedures. Endoscopic procedures are frequently performed in the context of multidisciplinary management with bariatric surgeons and interventional radiologists. Treatment algorithms and standards of practice for endoscopic management will continue to be refined as new dedicated technology and data emerge.
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Hamed H, Elghadban H, Ezzat H, Attia M, Sanad A, El Sorogy M. Gastric Stenosis After Sleeve Gastrectomy: an Algorithm for Management. Obes Surg 2020; 30:4785-4793. [PMID: 32683638 DOI: 10.1007/s11695-020-04858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gastric stenosis (GS) is a well-recognized complication after sleeve gastrectomy (SG) with a negative impact on patients' nutritional status and quality of life. There is no consensus on a validated, comprehensive management algorithm for GS. This study evaluates treatment modalities and proposes a management algorithm for obstructive gastric symptoms (OGSs) after SG. METHODS This is a retrospective cohort study of patients with GS after SG between January 2013 and January 2019. Patients with concomitant GS and staple-line leak were excluded. The primary outcome was the clinical response to treatment. RESULTS Forty-nine patients presented with OGSs. One patient underwent urgent surgical treatment for acute migration of cardia. Of 42 patients who had evident GS, pneumatic balloon dilatation (PBD) achieved clinical success in 28 (66.7%) patients. Six patients were diagnosed with indolent GS, and four of them improved after empirical PBD. The mean interval from index surgery to PBD was 5.3 (± 4.2) months. Longer duration of PBD session was associated with better clinical outcomes (5.8 ± 3.7 vs. 3.2 ± 1.7 min) (P = 0.017). After failed PBD, endoscopic stenting (n = 2) and revisional surgery (n = 7) were performed with clinical success in all patients. CONCLUSION PBD using achalasia balloon is the mainstay of treatment with good clinical outcomes. The utility of endoscopic stenting for GS should be different from its use for leakage in aspects of dwelling time and required endoscopic expertise. RYGB is the gold standard revisional procedure due to the high success rate and technical familiarity. Controversial aspects of management require future prospective comparative studies.
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Affiliation(s)
- Hosam Hamed
- Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt.
| | - Hosam Elghadban
- General Surgery Department, Mansoura University, Jehan street, Mansoura, Dakahleyya, Egypt
| | - Helmy Ezzat
- Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt
| | - Mohamed Attia
- Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt
| | - Amr Sanad
- Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt
| | - Mohamed El Sorogy
- Gastrointestinal Surgical Center, Mansoura University, Jehan street, Mansoura, Dakahleyya, 35516, Egypt
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Brunaldi VO, Galvao Neto M, Zundel N, Abu Dayyeh BK. Isolated sleeve gastrectomy stricture: a systematic review on reporting, workup, and treatment. Surg Obes Relat Dis 2020; 16:955-966. [DOI: 10.1016/j.soard.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 12/11/2022]
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Kirakosyan EV, Lokhmatov MM, Budkina TN, Tupylenko AV, Oldakovsky VI, Dyakonova EY. [Staged endoscopic balloon dilatation for cicatricial pyloric stenosis in children]. Khirurgiia (Mosk) 2019:85-90. [PMID: 31464281 DOI: 10.17116/hirurgia201908185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Secondary pyloric stenosis quickly leads to homeostatic and nutritional disorders that determines the importance of early diagnosis and surgical treatment. In two clinical cases, we have shown that staged endoscopic balloon dilatation of the pylorus is devoid of the most of the known problems and shortcomings of conventional surgery and makes it possible to restore effectively gastrointestinal passage and to improve child's quality of life. This procedure has a high diagnostic and curative value and is followed by positive dynamics of condition of the child with pyloric stenosis.
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Affiliation(s)
- E V Kirakosyan
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia
| | - M M Lokhmatov
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia; National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - T N Budkina
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Tupylenko
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - V I Oldakovsky
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - E Yu Dyakonova
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
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Deslauriers V, Beauchamp A, Garofalo F, Atlas H, Denis R, Garneau P, Pescarus R. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis. Surg Endosc 2017; 32:601-609. [PMID: 28726143 DOI: 10.1007/s00464-017-5709-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/05/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery worldwide. Gastric sleeve stenosis is the most common postoperative complication, occurring in up to 3.9% of the cases. Current treatment options include endoscopic treatments, such as dilatations and stent placement as well as surgical revisions such as laparoscopic Roux-en-Y gastric bypass (LRYGB), wedge gastrectomy or seromyotomy. METHODS A retrospective analysis of our prospectively collected therapeutical endoscopy database was performed between January 2014 and February 2017. We included all cases of axial deviation or stenosis post LSG, which were treated endoscopically. Patients with concomitant sleeve leaks were excluded. Endoscopic interventions were performed under general anaesthesia and fluoroscopic assistance when needed. Sequential treatment with CRE balloons, achalasia balloons (30-40 mm) and fully covered stent placement for refractory cases was performed. RESULTS A total of 1332 LSG were performed. Overall, 27/1332 patients (2%) developed a gastric stenosis. All patients presented an axial deviation at the incisura angularis and 26% had a concomitant proximal stenosis. Successful endoscopic treatments were performed in 56% (15/27) of patients, 73% of the successful patients underwent a single dilatation procedure. All successful cases had a maximum of 3 interventions. The unsuccessful cases (44%) underwent LRYGB. Mean time between the primary surgery and the diagnosis of the stenosis was 10.3 months. Mean follow-up after the endoscopic treatment was 11.5 months. A stent migration was the only complication (3.7%) recorded. CONCLUSIONS Endoscopic treatment appears to be effective in 56% of patients with post-LSG stenosis. Only one session of achalasia balloon dilatation is necessary in 73% of successful cases. Pneumatic balloon dilatation seems to be a safe procedure in this patient population. Surgical revision into a LRYGB offers good outcomes in patients that have failed three consecutive endoscopic treatments.
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Affiliation(s)
- Valérie Deslauriers
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Amélie Beauchamp
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Fabio Garofalo
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Henri Atlas
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Ronald Denis
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Pierre Garneau
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Radu Pescarus
- Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Département de Chirurgie, Université de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada.
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