Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

Abstract

AIMTo evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG).METHODSVSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.RESULTSOf 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.CONCLUSIONNarrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

Endoscopía luego de cirugía bariátrica: Lo que debe saber el endoscopista

“…En el caso de las estenosis post gVt, la tasa de éxito va desde 44% a 100% 71,72 y pueden ser manejadas con dilatación con balón o posicionamiento de stents. La tabla 3 67,[71][72][73][74][75][76][77][78][79] resume las series publicadas para el manejo de las estenosis post gVt y sus resultados.…”

Metabolic and Bariatric Surgery: Evolution, Techniques, and Management

“…With respect to complications, such as staple line or anastomotic leaks, sleeve stenosis, gastrojejunostomy stenosis, gastrogastric fistulae, gastropleural fistulae, and others, the preferred approach of any experienced bariatric surgeon is usually endoscopic, not surgical. Endoscopic intervention has the ability to provide good results with less morbidity and mortality compared to revisional surgery, unless there is no more room for endoscopy after failure of this type of therapy [45][46][47]. The use of esophageal stents initially developed for the treatment of esophageal cancer has revolutionized the treatment of bariatric complications and is a skill that must be learned by all bariatric surgeons.…”

Organization of future training in bariatric gastroenterology

“…The trainees could then be instructed in postoperative care of patients who have undergone bariatric surgery. Trainees could be trained in the management of adjustable gastric bands, postoperative nutritional disorders[ 52 ], postoperative symptoms and, as mentioned above, complications after Roux-en-Y gastric bypass surgery[ 3 ], and the management of major complications of vertical sleeve gastrectomy including gastric perforation or leak[ 53 ] and vomiting/dysphagia[ 54 ].…”