Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Surg Obes Relat Dis. 2012 Mar-Apr;8(2):151-7. doi: 10.1016/j.soard.2011.01.043. Epub 2011 Mar 11.
Endoscopic balloon dilation is an effective treatment of gastrojejunal (GJ) strictures after Roux-en-Y gastric bypass (RYGB), although its success might depend on the point at which they occur postoperatively. We hypothesized that "late" strictures (≥90 d after RYGB) might be less amenable to balloon dilations than "early" strictures occurring within 90 days postoperatively.
A review of a prospectively maintained database at a bariatric center was conducted to identify all patients who underwent upper endoscopy (UE) for investigation of gastrointestinal symptoms after RYGB. Those who were diagnosed with a GJ anastomotic stricture at endoscopy were selected for additional evaluation. The patients were classified into 1 of 3 groups, according to the point at which they presented with stricture symptoms (group 1, 0-90 d after RYGB; group 2, 91-365 d after RYGB; and group 3, >1 yr after RYGB). All strictures were dilated using through-the-scope controlled radial expansion balloons.
From July 2006 to July 2009, 929 RYGB procedures were performed in our bariatric unit. Our surgical endoscopy team performs approximately 1500 UE investigations annually. Most investigations were for preoperative assessment of bariatric patients; however, a proportion is indicated for the investigation of postoperative weight regain and complications of foregut surgery, as well as endoluminal surgery. In the present study period, 591 gastric bypass patients underwent UE for investigation of gastrointestinal symptoms postoperatively. In total, 72 patients were diagnosed with a symptomatic GJ anastomotic stricture and underwent balloon dilation. Almost two thirds (63.9%) of the dilations were performed within 90 days after RYGB; 98% of these "early" strictures resolved with dilation. In comparison, of the "late" strictures, only 61% (16 of 26 patients) resolved and 38.5% (n = 10) required revisional surgery for additional management.
Endoscopic balloon dilation is effective in treating early GJ strictures after RYGB. Late strictures are less amenable to endoscopic dilation and often require revisional surgery. Patients presenting with upper gastrointestinal symptoms after RYGB warrant early investigation with UE to investigate for a GJ stricture, which if present, should be promptly dilated.
内镜球囊扩张是治疗 Roux-en-Y 胃旁路术后（RYGB）胃空肠（GJ）狭窄的有效方法，尽管其成功可能取决于术后发生的时间点。我们假设“晚期”狭窄（RYGB 后≥90 天）可能不如术后 90 天内发生的“早期”狭窄更适合球囊扩张。
对一家减肥中心前瞻性维护的数据库进行了回顾性分析，以确定所有因 RYGB 后胃肠道症状接受上消化道内镜（UE）检查的患者。对在内镜下诊断为 GJ 吻合口狭窄的患者进行了进一步评估。根据出现狭窄症状的时间点，将患者分为 3 组：第 1 组为 RYGB 后 0-90 天；第 2 组为 RYGB 后 91-365 天；第 3 组为 RYGB 后>1 年。所有狭窄均采用经内镜控制的径向扩张球囊进行扩张。
2006 年 7 月至 2009 年 7 月，我们的减肥单位进行了 929 例 RYGB 手术。我们的外科内镜团队每年进行约 1500 次 UE 检查。大多数检查是为了术前评估减肥患者；但是，也有一部分是为了检查术后体重反弹和上消化道手术并发症，以及内镜手术。在本研究期间，591 例 RYGB 患者因术后胃肠道症状接受 UE 检查。共有 72 例患者被诊断为有症状的 GJ 吻合口狭窄，并进行了球囊扩张。近三分之二（63.9%）的扩张发生在 RYGB 后 90 天内；这些“早期”狭窄中有 98%通过扩张得到解决。相比之下，“晚期”狭窄中只有 61%（26 例患者中的 16 例）得到解决，38.5%（n=10）需要进行翻修手术以进行额外的治疗。
内镜球囊扩张治疗 RYGB 后早期 GJ 狭窄是有效的。晚期狭窄对内镜扩张的反应较差，往往需要翻修手术。RYGB 后出现上消化道症状的患者需要进行早期 UE 检查以检查 GJ 狭窄，如果存在狭窄，应及时进行扩张。
