Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en-Y gastric bypass

Background: Common endoscopic findings in patients who have undergone Roux-en-Y gastric bypass (RYGB) with chronic abdominal pain have included marginal ulceration, gastrogastric fistula, and jejunal erosion However. suture or staples eroding into the gastric pouch can also contribute to abdominal pain Redundant suture is typically regarded as a normal part of the postoperative anatomy The objectives of the present study were to assess the effects of endoscopc foreign body removal of partially exposed sutures and staples in post-RYGB patients with chronic abdominal pain at a university hospital in the United States Methods: We performed a retrospective study of consecutive patients from January 2006 to July 2007 Post-RYGB patients with chronic abdominal pain underwent endoscopic foreign body removal of exposed sutures/staples Pain scores were obtained before the procedure, immediately after the procedure, and at the telephone follow-up (median 7 2 months) Results: Of 21 patients, 15 (71%) reported immediate symptomatic improvement Specific endoscope accessories were found to be more useful than others in managing the various foreign materials Of the 21 patients, 15 (71%) were available for telephone follow-up Of these 15 patients, 13 (87%) reported continued symptomatic improvement, with 9 (60%) reporting complete pain resolution and 4 (27%) reporting partial improvement Eroded foreign material was seen in association with marginal ulcers in 3 patients (14%), gastritis in 7 patients (33%), and an inflammatory polyp in 1 patient (5%) Conclusions: Eroded suture and staples can cause chronic abdominal pain in post-RYGB patients In symptomatic patients, visible suture or staples should be considered a potential etrology of chronic pain, instead of normal postoperative findings Endoscopic foreign body removal might be of therapeutic benefit in these patients (Surg Obes Relat Dis 2010,6 526-531) (c) 2010 American Society for Metabolic and Bariatric Surgery All rights reserved