Abstract
Background
Gastric sleeve stenosis (GSS) is described in 1%–4% of patients.
Objective
To evaluate the role of endoscopy in the management of stenosis after laparoscopic
sleeve gastrectomy using a standardized approach according to the characteristic of
stenosis.
Setting
Retrospective, observational, single-center study on patients referred from several
bariatric surgery departments to an endoscopic referral center.
Methods
We enrolled 202 patients. All patients underwent endoscopy in a fluoroscopy setting,
and a systematic classification of the type, site, and length of the GSS was performed.
According to the characteristics of the stenosis, patients underwent pneumatic dilatation
or placement of a self-expandable metal stent or a lumen-apposed metal stent. Failure
of endoscopic treatment was considered an indication for redo surgery, whereas patients
with partial or complete response were followed up for 2 years. In the event of a
recurrence, a different endoscopic approach was used.
Results
We found inflammatory strictures in 4.5% of patients, pure narrowing in 11%, and functional
stenosis in 84.5%. Stenosis was in the upper tract of the stomach in 53 patients,
whereas medium and distal stenosis was detected in 138 and 11 patients, respectively,
and short stenosis in 194 patients. A total of 126 patients underwent pneumatic dilatation,
8 self-expandable metal stent placement, 64 lumen-apposed metal stent positioning,
and 36 combined therapy. The overall rate of endoscopy success was 69%.
Conclusion
GSS should be considered to be a chronic disease, and the endoscopic approach seems
to be the most successful treatment, with a prolonged positive outcome of 69%. Characteristics
of the stenosis should guide the most suitable endoscopic approach.
Keywords
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Article info
Publication history
Published online: October 04, 2022
Accepted:
September 25,
2022
Received:
May 24,
2022
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
