Gastric Outlet Obstruction Following Surgery for Morbid Obesity: Efficacy of Fluoroscopically Guided Balloon Dilation

Vance, Peter L.; Lange, Eduard E. de; Shaffer, Hubert A.; Schirmer, Bruce D.

doi:10.1148/radiol.2221010640

Cited by 38 publications

(21 citation statements)

References 9 publications

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“…Dilations using Savary-Gilliard bougies were performed in a total of four studies (Figure 2). The use of other types of balloon such as angioplasty-type polyethylene balloon catheters 30 , polyvinyl chloride and polyethylene balloons 20 , and pneumatic balloons 26 was also reported. One study did not state the type or diameter of dilator used 23 .…”

Section: Resultsmentioning

confidence: 99%

“…Huang et al 13 proposed that endoscopic dilation should not exceed 15 mm, to avoid weight regain, and this same author proposed in a later paper that the TTS balloon should be inflated to at least 15 mm to reduce the recurrence rate of stenosis 14 . Vance et al reported perforations in three primary dilations using a 15 mm balloon 30 , but some initial dilations used balloons up to 20 mm in diameter 29 . Escalona et al 11 and Fernández-Esparrach et al 12 used Savary-Gilliard bougies for endoscopic therapy, reporting 71 and 38 dilation procedures, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Campos

Mello

Ferraz

et al. 2012

ABCD, arq. bras. cir. dig.

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-Introduction -Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. Aim -Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. Methods -The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. Results -The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. Conclusion -Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings. ABCDDV/885RESUMO -Introdução -Bypass gástrico em Y-de-Roux pode resultar em estenose de anastomose gastrojejunal. Não há protocolo de tratamento bem definido para essa complicação. Objetivo -Analisar os resultados da dilatação endoscópica em pacientes com estenose, através de revisão sistemática, incluindo complicações e taxa de sucesso.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Campos

Mello

Ferraz

et al. 2012

ABCD, arq. bras. cir. dig.

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“…Other techniques that may be required include imaging-guided placement of jejunal feeding tubes in cases of gastrojejunal complications in RYGB, and imaging-guided gastrostomy of the gastric remnant for temporary decompression in cases of BP limb distension secondary to obstruction at the jejunojejunostomy [40]. Although most often performed via endoscopy, stenosis at the gastrojejunal anastomosis can also be dilated with the aid of fluoroscopic guidance [41]. In addition, percutaneous transhepatic techniques can be used in the management of biliary complications such as choledocholithiasis in RYGB patients, as conventional endoscopic access to the biliary tree is limited in this group [42].…”

Section: Role Of Interventional Radiologymentioning

confidence: 99%

Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

Shah¹,

Shah²,

Ahmed³

et al. 2011

BJR

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ABSTRACT. Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and provide an overview of the most frequently performed procedures, normal postoperative imaging findings and the appearance of common complications. ObesityObesity is a multifactorial disease, which is increasing in incidence and prevalence. In 2006, 67% of men and 56% of women were classified as being either overweight or obese in England [1]. Overall, 24% of adults were classified as obese, an increase from 15% in 1993, and 16% of children aged 2-15 years were classified as obese, an increase from 11% in 1995. Estimates suggest that at the current rate of increase, by 2010 there will be 12 million adults and 1 million children categorised as obese. The body mass index (BMI, kg m -2 ) is the most widely used measure of obesity; BMI between 25 and 30 signifies being overweight and BMI greater than 30 signifies obesity. BMI greater than 35 with obesityrelated serious comorbidities or greater than 40 with or without comorbidities is defined as morbid obesity.

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“…This procedure can be guided by either fluoroscopy or upper gastrointestinal endoscopy, with a reported effectiveness of 50% to 100% [1,2,10,15,19].…”

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confidence: 99%

Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary–Gilliard dilator

et al. 2007

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Gastric Outlet Obstruction Following Surgery for Morbid Obesity: Efficacy of Fluoroscopically Guided Balloon Dilation

Abstract: Among patients with symptoms of obstruction following gastric surgery for morbid obesity, 50% experienced relief of symptoms following FGBD.

Cited by 38 publications

References 9 publications

Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary–Gilliard dilator

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