Endoscopic balloon dilation of stomal stenosis following gastric bypass

Background: Roux-en-Y gastric bypass (RYGBP) is a common operation for severely obese patients, particularly those with co-morbid disease. Postoperative complications include those amenable to endoscopic therapy, specifically those involving the gastric stoma. Methods: 26 patients with prior history of RYGBP for morbid obesity presented with symptoms of gastric outlet obstruction. Symptoms included accelerated weight loss (n=22), nausea/vomiting (n=26), dehydration (n=5), and dysphagia, (n=2). Endoscopic dilatation was performed using through-the-scope dilating balloons (8-15 mm). Following dilatation, a steroid solution was injected to prevent re-stenosis. Results: Patients underwent 1-7 dilating sessions (mean 2.7/patient) at 2-week intervals. Estimated stoma diameter prior to dilation ranged from 1 mm to 8 mm (mean 3.5). Following dilation, diameter of the stoma increased to 10 to 15 mm (mean 12.4) at final endoscopy. In patients requiring a single dilating session (n=7), pre-dilation stoma size was a mean 5.8 mm (range 3-8 mm), which increased to a mean of 12.7 mm (range 10-15 mm). In patients requiring multiple dilating sessions (n=19), pre-dilation stoma size was a mean of 2.7 mm (range 0-4 mm), which increased to a mean of 12.2 mm (range 10-14 mm). 25 of 26 patients had good long-term response, with follow-up of 6-38 months (mean 26). No treatment-related complications occurred. All had appropriate weight loss as determined at the bariatric clinic following endoscopic therapy. Conclusions: Of the complications following bariatric surgery that are amenable to endoscopic therapy, stomal stenosis appears to be relatively common. Endoscopic balloon dilation is an effective nonsurgica method for treatment of stomal stenosis, with no complications observed in this, the largest reported, series.