Food Intolerance After Banded Gastric Bypass Without Stenosis: Aggressive Endoscopic Dilation Avoids Reoperation

Abstract

Aggressive endoscopic dilation for food intolerance is a safe and minimally invasive method that promotes symptom improvement. It avoided reoperation in 96.8 % of patients and led to a low rate of weight regain.

Endoscopic treatment of food intolerance after a banded gastric bypass: inducing band erosion for removal using a plastic stent

“…Despite these advantages, rings are related to food intolerance and gastric outlet complications. These may lead to vomiting, excessive weight loss, and malnutrition [6,7]. Historically, the treatment for ring-related complications has been surgical removal of the ring.…”

“…However, these procedures can be associated with morbidities, such as bleeding, pouch or limb perforation, and abdominal infection. In the long term, these procedures can also lead to weight regain as a result of pouch and gastrojejunostomy dilation [6,7]. The endoscopic approach for food intolerance in banded RYGB has been limited to balloon dilation, but this is not always successful in resolving the symptoms [7,8].…”

“…In the long term, these procedures can also lead to weight regain as a result of pouch and gastrojejunostomy dilation [6,7]. The endoscopic approach for food intolerance in banded RYGB has been limited to balloon dilation, but this is not always successful in resolving the symptoms [7,8]. In addition, dilation may not even be necessary in some cases, as gastric outlet dysfunction can occur without stricture of the pouch [7].…”

Endoscopic Diagnosis and Treatment of Bariatric Surgery Complications

“…It is important to note, however, that vomiting can occur even in the absence of stenosis. 17 In case of obstruction in the absence of erosion, a classic dilation is an option. It can be used after vertical banded gastroplasty or RYGB with a ring.…”

“…For this, gradual balloon inflation is recommended, preventing oscillation of the catheter during the procedure. 17 Dilation is not indicated in the adjustable gastric band ("with a locker") and if there is a sign of ischemia around the ring, due to the risk of perforation. 17 In cases of ring erosion, the endoscopic treatment is possible (►Fig.…”