Ahmad J, Martin J, Ikramuddin S, Schauer P, Slivka A
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Endoscopy. 2003 Sep;35(9):725-8. doi: 10.1055/s-2003-41579.
Laparoscopic gastric bypass is a recently introduced treatment option for morbid obesity, with promising initial results. Stenosis of the gastroenterostomy is a recognized complication. The efficacy and safety of endoscopic balloon dilation for the management of this type of anastomotic stenosis has not been studied.
450 patients who underwent laparoscopic gastric bypass at our institution were followed prospectively. All patients had a 15 ml gastric pouch and either a 75 cm or 150 cm jejunal Roux limb depending on whether obesity was morbid (body mass index (BMI) < 50 kg/m 2) or super-morbid (BMI > 50 kg/m 2). Patients who developed symptoms compatible with stenosis of the gastrojejunostomy were referred for upper gastrointestinal endoscopy.
14 patients, 11 women and three men, underwent a total of 27 endoscopies, with 23 balloon dilations. Their average age was 46 years (range 33 - 59 years), average preoperative BMI was 47 kg/m 2, and they presented an average of 2.7 months after surgery (range 0.3 - 15.7 months). Of the 14 patients, 13 had a stricture of the gastrojejunostomy and one patient had edema. For initial dilation, a 15 mm hydrostatic balloon was used in 12 patients and an 18 mm balloon in two patients. There was response to treatment with the 15 mm balloon in seven of the 12 patients (58 %), and they required no further dilation; in one there was a response to a further 15 mm balloon dilation; in three patients a response to subsequent 18 mm balloon dilation; and one patient required 18 mm and 25 mm balloon dilations. The two patients treated with an initial 18 mm balloon dilation required no further dilations. The average length of follow-up after successful dilation was 18 months (range 7 - 30 months). There were no complications with any of the 23 dilations performed.
Stenosis of the gastroenterostomy after laparoscopic gastric bypass occurred in 3.1 % of the patients in this series. It can be successfully and safely treated with endoscopic balloon dilation with good long-term follow-up.
腹腔镜胃旁路术是一种最近引入的治疗病态肥胖的方法，初步结果令人满意。胃肠吻合口狭窄是一种公认的并发症。内镜球囊扩张术治疗此类吻合口狭窄的疗效和安全性尚未得到研究。
对在我院接受腹腔镜胃旁路术的450例患者进行前瞻性随访。所有患者均有一个15毫升的胃囊，根据肥胖是病态（体重指数（BMI）<50kg/m²）还是超级病态（BMI>50kg/m²），分别采用75厘米或150厘米的空肠 Roux 袢。出现与胃肠吻合口狭窄相符症状的患者被转诊进行上消化道内镜检查。
14例患者（11例女性和3例男性）共接受了27次内镜检查，其中23次为球囊扩张术。他们的平均年龄为46岁（范围33 - 59岁），术前平均BMI为47kg/m²，平均在术后2.7个月出现症状（范围0.3 - 15.7个月）。14例患者中，13例有胃肠吻合口狭窄，1例有水肿。初次扩张时，12例患者使用15毫米水压球囊，2例患者使用18毫米球囊。12例使用15毫米球囊的患者中有7例（58%）对治疗有反应，无需进一步扩张；1例对再次使用15毫米球囊扩张有反应；3例患者对随后的18毫米球囊扩张有反应；1例患者需要18毫米和25毫米球囊扩张。最初接受18毫米球囊扩张治疗的2例患者无需进一步扩张。成功扩张后的平均随访时间为18个月（范围7 - 30个月）。23次扩张均未出现并发症。
本系列中3.1%的患者在腹腔镜胃旁路术后发生胃肠吻合口狭窄。通过内镜球囊扩张术可成功、安全地治疗，且长期随访效果良好。
