Endoscopy of the Partitioned Stomach

Abstract

Fiberoptic endoscopy is an important diagnostic modality for evaluation of the patient with upper gastrointestinal (GI) tract symptoms following gastric bypass and gastroplasty. During a 3 yr period, 182 patients underwent gastric partitioning procedures and 22 patients (12%) developed upper GI symptoms requiring endoscopic evaluation. Patients (8) had undergone Mason vertical banded gastroplasty, 12 patients had undergone Gomez gastroplasty and 2 patients had undergone Roux-en-Y gastric bypass. In 4 of 5 patients with abdominal pain, gastritis of the proximal pouch was observed. Of the 2 patients with proximal gastric outlet obstruction symptoms, 1 patient was found to have a cherry pit occluding the channel. Intraoperative endoscopy was performed in 1 patient who developed upper GI bleeding after Roux-en-Y gastric bypass, the pylorus was scarred and stenotic and multiple superficial ulcerations were seen in the excluded distal stomach. In 8 patients with symptoms suggestive of channel stenosis, 4 were found to have a stenotic channel and underwent endoscopic dilation of the channel. Upper GI endoscopy was performed in 8 patients with Gomez gastroplasty to confirm suspected dilatation of the channel between the upper and lower gastric pouches. Upper GI contrast studies did not estimate accurately the diameter of the channel as determined during endoscopy. No complications were observed following any of the endoscopic procedures. As the collective experience with gastric partitioning procedures increases, the need for upper GI tract endoscopic examinations will also increase. Endoscopists should be familiar with the altered gastric anatomy and with the spectrum of upper GI lesions that develop following these operations.