Balloon dilatation for symptomatic gastric sleeve stricture

Evolving Endoscopic Management Options for Symptomatic Stenosis Post-Laparoscopic Sleeve Gastrectomy for Morbid Obesity: Experience at a Large Bariatric Surgery Unit in New Zealand

“…The caution with the use of achalasia balloon dilators is that the standard flexible guide wire that is included in the kit is not very helpful in positioning the balloon into the distal sleeve (a position that the Rigiflex dilators are not designed to reach). In a recent study, Shnell et al reported success with the Rigiflex achalasia balloon dilators but were not able to introduce the balloon in all cases due to limitation of the length of the introducer particularly in a rotated sleeve [12]. Our use of the stiffer metal Peustow wire (used for oesophageal dilatation with Savary-Gillard dilators) was successful in all cases.…”

“…The adverse event rates for these surgical procedures seem to be very high, and the success rates are not encouraging [11]. Two recent studies [12,13] report the use of pneumatic achalasia balloon dilators in a small number of patients. One of these case series reported difficulty of insertion of the achalasia balloon dilator in some cases [12].…”

“…Two recent studies [12,13] report the use of pneumatic achalasia balloon dilators in a small number of patients. One of these case series reported difficulty of insertion of the achalasia balloon dilator in some cases [12]. Our experience has included balloon dilatation, removable stent insertion and a method of dilatation of the strictures with a longer and wider balloon (Rigiflex II) usually used for achalasia dilatation.…”

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

“…In patients with LSG, functional stenosis may occur at the angularis incisura or the gastroesophageal junction and endoscopic treatment seems to play a smaller role based on the lower efficacy rates. In a study of 16 patients who underwent TTS balloon dilation under fluoroscopic or endoscopic guidance, the efficacy was only 44% after 1 to 3 sessions[53]. Repeated sessions of endoscopic dilation should be indicated only in patients with some symptomatic relief following the first session because these strictures are more likely due to a fibrotic reaction.…”

Endoscopic management of bariatric surgical complications

“…The prevalence of symptomatic stenosis following sleeve gastrectomy ranges between 0.1 and 3.9%. These stenoses have been traditionally managed with single or multiple through-the-scope balloon dilation (up to 20 mm) although therapeutic success is achieved in only 44% [27,28]. There are increasing reports of the use of a 30 mm achalasia balloon (Rigiflex, Boston Scientific, Natick, Massachusetts, USA) to treat sleeve gastrectomy strictures.…”