Evolving Endoscopic Management Options for Symptomatic Stenosis Post-Laparoscopic Sleeve Gastrectomy for Morbid Obesity: Experience at a Large Bariatric Surgery Unit in New Zealand

Abstract

Symptomatic stenosis is an increasingly recognised complication following laparoscopic sleeve gastrectomy (LSG) to treat obesity with a reported prevalence between 0.1 and 3.9 %. This study aimed to determine the prevalence and management options for symptomatic stenosis (SS) after LSG. A total of 857 patients underwent LSG at Counties Health Auckland New Zealand between May 2008 and June 2013. All cases referred for management of symptomatic stenosis after LSG were recorded. Symptomatic stenosis developed in 26 (3.03 %) out of 857 receiving LSG confirmed by barium swallow. Three of these 26 patients developed a fixed stenosis in the proximal stomach. These were all successfully treated by one dilatation of controlled radial expansion (CRE) balloon of 3 cm long were initially treated with the achalasia balloon. Five were successfully dilated, but two required temporary placement of a SEMS. None of the 26 patients required a surgical procedure to correct their stenosis. The use of a 30-mm achalasia balloon and a SEMS is an effective and safe treatment for patients with SS post-LSG who do not respond to dilatation. Achalasia balloon could be the first-line treatment in selected cases.