Background Laparoscopic gastric bypass is a recently introduced treatment option for morbid obesity, with initial promising
RESULTS: Stenosis of the gastrojejunostomy is a recognized complication but the safest and most effective therapy has not been studied. Methods 450 patients who underwent laparoscopic gastric bypass at our institution were followed prospectively. All patients had a 15cc gastric pouch and either a 75cm or 150cm jejunal Roux limb depending on morbid (body mass index (BMI) <50 kg/m2) or super-morbid obesity (BMI >50kg/m2) respectively. Patients who developed symptoms compatible with stenosis of the gastrojejunostomy were referred for upper GI endoscopy.
Results: 14 patients, 11 female and 3 male, underwent a total of 27 endoscopies, with 23 through the scope, hydrostatic balloon dilations. Their average age was 46 years (range 33-59 years), average preoperative BMI was 47 kg/m2, and they presented an average of 2.7 months after surgery (range 0.3-15.7 months). All patients had had dramatic weight loss and presented with post-prandial vomiting as the predominant symptom of gastric outlet obstruction. Thirteen of 14 patients had a stricture of the gastrojejunostomy and 1 patient had edema. Twelve patients were initially dilated with a 15mm balloon, and 2 patients with an 18mm balloon. Seven of the 12 patients (58%) treated with the 15mm balloon responded and required no further dilation, 1 responded to a further 15mm balloon dilation, and the other 4 patients responded to subsequent 18mm balloon dilation. The 2 patients treated with initial 18mm dilation required no further dilations. The average length of follow-up after successful dilation was 18 months (range 7-30 months). There were no perforations with any of the 23 dilations performed.
Conclusion: Stenosis of the gastrojejunostomy after laparoscopic gastric bypass occurred in 3.1% of the patients in this series. It can be successfully and safely treated with endoscopic balloon dilation with good longterm follow-up.