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

Ogra, Ravinder; Kini, Geogry Peter

doi:10.1007/s11695-014-1383-y

Cited by 70 publications

(46 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dysphagia is a commonly encountered symptom after VSG[13-15]. A novel feature of this present study is the use of a multivariate analysis to examine potential medical risk factors in individuals with post-operative dysphagia after VSG; individuals with endoscopic evidence for narrowing of their gastric sleeve are simultaneously treated by hydrostatic balloon dilatation of the sleeve to try to obtain relief from dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…Given the rapid rise in the number of VSGs performed, gastroenterologists will be frequently consulted for dysphagia in patients with history of VSG. The suggested treatment strategies to manage narrowing of the gastric sleeve include conservative medical therapy, endoscopic hydrostatic balloon dilation, pneumatic achalasia balloon dilation, or surgical intervention[13-15]. Due to a lack of evidence, currently there are no guidelines for a standardized management plan for symptomatic narrowing of the gastric sleeve after VSG[15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Nath¹,

Yewale²,

Tran³

et al. 2016

WJG

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Nath¹,

Yewale²,

Tran³

et al. 2016

WJG

View full text Add to dashboard Cite

show abstract

“…91 The prevalence of symptomatic stenosis following LSG is between 0.1% and 3.9%. 92 Patients typically present with obstructive symptoms including nausea, vomiting, early satiety, reflux, and dysphagia. 19 The primary treatment for stenosis is through-thescope balloon dilation or wire-guided bougie dilation.…”

Section: Stricture and Stenosismentioning

confidence: 99%

Endoscopic Management of Bariatric Surgery Complications

Cai

Schweitzer²,

Kumbhari³

2016

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Obesity is a global epidemic that has significant impact on morbidity, mortality, and rising health care costs. In morbidly obese patients with body mass index >40 kg/m2, bariatric surgery is a grade A recommendation and is associated with up to 40% reduction in premature death. Increasingly, endoscopy is seen as a safer and more cost-effective approach to the management of weight loss surgery complications including gastrointestinal bleeding, development of anastomotic ulcers, staple-line leaks and fistulas, strictures, weight regain, bezoars, choledocholithiasis, and gastric band erosion and slippage. Many endoscopic interventions currently rely on a combination of specialized equipment, such as stents, suture systems, clips, and balloon dilators to successfully treat these issues. This article will present common postoperative complications in bariatric surgery, discuss the latest evidence for their endoscopic management, and offer future directions in the endoluminal therapy of obese patients.

show abstract

“…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.…”

Section: Key Pointsmentioning

confidence: 99%

Endoscopic management of bariatric surgical complications

Kumbhari

Cai

Schweitzer

2015

Current Opinion in Gastroenterology

View full text Add to dashboard Cite

show abstract

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

Abstract: The use of a 30-mm achalasia balloon and a SEMS is an effective and safe treatment for patients with SS post-LSG who do not respond to dilatation. Achalasia balloon could be the first-line treatment in selected cases.

Cited by 70 publications

References 21 publications

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

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

Endoscopic Management of Bariatric Surgery Complications

Endoscopic management of bariatric surgical complications

Contact Info

Product

Resources

About