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Endoscopy Identified as Safe and Effective Method in Treating Common Complication of Gastric Bypass Surgery
Date:8/19/2007

ctively. Endoscopy remains the cornerstone of diagnosis and therapy for this complication, and surgical revision is rarely necessary," said the study's lead author Kevin J. Peifer, MD, clinical assistant professor, University of Illinois, College of Medicine at Rockford, Ill., and formerly an advanced endoscopic fellow at the Washington University School of Medicine. "As the number of gastric bypass procedures grows, it will become increasingly important for surgeons and gastroenterologists to recognize and treat the complications that may arise."

Patients and Methods

Stricture of the gastrojejunal anastomosis is a common complication of both open and laparoscopic Roux-en-Y gastric bypass surgeries (the most frequently performed bariatric surgery for morbid obesity). In a single- center retrospective study of 801 morbidly obese patients who underwent Roux- en-Y gastric bypass surgery between 1997 and 2005 at the Washington University School of Medicine, 43 patients developed anastomotic stricture.

Upper endoscopy was performed in patients who were vomiting, which raised concern for anastomotic narrowing, by using the standard gastroscope, with an outer diameter of 8.6 mm. A gastrojejunal anastomotic stricture was identified as a narrowing at the anastomosis that prevented passage of the gastroscope in these symptomatic patients.

Results

Seventy-nine percent of patients were successfully managed with a single balloon dilation. Ninety-three percent of patients were successfully dilated with one or two endoscopic sessions, all without perforation or significant bleeding. Only one patient in the study required surgery for revision of an anastomosis that was not responsive to endoscopic therapy.

At the Washington University School of Medicine, the anastomotic strictures are routinely dilated to at least 15 mm during the initial endoscopy. Other groups have raised the concern that overly aggressive dilation of the stricture may allow pa
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SOURCE American Society for Gastrointestinal Endoscopy

Copyright©2007 PR Newswire.

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