Endoscopy management of Sleeve Gastrectomy Stenosis. What we learned from 202 consecutive patients


Abstract

Background

Gastric sleeve stenosis (GSS) is described in 1-4% of patients.

Objective

To evaluate the role of endoscopy in the management of post Laparoscopic Sleeve Gastrectomy
(LSG) stenosis, using a standardized approach according to the characteristic of stenosis.

Setting

Retrospective, observational, single center study on patients referred from several
bariatric surgery departments to an endoscopic referral center.

Methods

We enrolled 202 patients. All patients underwent endoscopy in a fluoroscopy setting,
a systematic classification of type, site, and length of the GSS was performed. According
to the characteristics of the stenosis, patients underwent pneumatic dilatation, Self-Expandable-Metal-Stent
(SEMS) or Lumen-Apposed-Metal-Stent (LAMS) placement. Failure of endoscopic treatment
was considered an indication for redo-surgery, while patients with partial or complete
response were followed up for 2 years. In case of recurrence a different endoscopic
approach was performed.

Results

We found inflammatory strictures in 4.5%, pure narrowing in 11%, and functional stenosis
in 84.5% of patients. Stenosis was in the upper tract of the stomach in 53 patients,
while medium and distal stenosis was detected in 138 and 11 patients, short stenosis
in 194 out of 202 patients. 126 patients underwent to pneumatic dilatation, 8 to SEMS
placement, 64 to LAMS position and 36 to combined therapy. Overall rate of endoscopy
success was 69%.

Conclusion

GSS should be considered as a chronic disease and endoscopic approach seems to be
the most successful treatment with a prolonged positive outcome of 69%. Characteristics
of the stenosis should guide the most suitable endoscopic approach.

Article Info

Publication History

Publication stage

In Press Journal Pre-Proof

Footnotes

The authors have no financial arrangements or commercial associations that might constitute a conflict of interest in relation to this manuscript.

Authors contributors

Gianfranco DONATELLI performed endoscopic procedure, conception and drafting of the manuscript and final approval.

Alessandra D’Alessandro, Francesco Zito, Fabrizio Cereatti: acquisition, analysis and interpretation of data and manuscript drafting.

Fabrizio Cereatti: manuscript draft, revision of the manuscript for important intellectual content and final approval.

Jean-Loup Dumont, Giovanni Galasso, Thierry Tuszynski, Hugo Rotkopf: performance of endoscopic procedure and final approval of manuscript.

Ibrahim Dagher, Jean-Marc Catheline , Laurent Genser , Renaud Chiche, Guillaume Pourcher, Lionel Rebibo, Daniela Calabrese, Simon Msika, Filippo Pacini, Roberto Arienzo, Antonio D’Alessandro, Hadrien Tranchart, , Adriana Torcivia, Kostas Arapis,Jean-Marc Chevallier, Giovanni Domenico De Palma, Mario Musella: clinical management of patients before and after endoscopic treatment, data acquisition and follow up of patients and final approval of manuscript.

Identification

DOI: https://doi.org/10.1016/j.soard.2022.09.015

Copyright

© 2022 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.

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