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Background: Roux-en-Y gastric bypass (RYGB) is the most frequently performed bariatric surgery for morbid obesity in the United States. Gastrojejunal anastomotic strictures are a postoperative complication usually managed with endoscopic balloon dilation. The primary aim of this study is to compare the long-term weight loss between RYGB patients requiring endoscopic dilation of gastrojejunal anastomotic strictures to 15mm or higher and RYGB patients who did not have strictures. METHODS: Retrospective review of patients who underwent RYGB for morbid obesity between 1997 and 2008. Preoperative and postoperative body mass index (BMI), follow up weight, gastrojejunal anastomotic strictures and endoscopic balloon dilation were recorded. Percent excess body mass index loss (%EBMIL) was calculated. RESULTS: 1348 patients underwent Roux-en-Y gastric bypass. 43 patients (3.4%) underwent endoscopic balloon dilation for gastrojejunal anastomotic strictures (32 women, mean age 42.8±1.6, mean preoperative BMI 55.6±1.5), and 1305 patients did not (1077 women, mean age 45.6±0.3, mean preoperative BMI 54.4±0.4). Strictures were dilated to a mean of 16.4mm (range 15-20mm, median 15mm) at a mean of 66.7±6.8 days postoperatively (range 18-248 days, median 51 days). Two patients that were dilated to less than 15mm were excluded. 755 patients (55.9%) were followed for ≥1 year (mean 51.1 months). Patients who underwent endoscopic balloon dilation to 15mm or higher (n=31) followed for at least 1 year showed similar postoperative weight loss compared to the 722 patients not dilated (68.4% vs. 68.1% EBMIL, p=0.94). Multivariate logistic regression comparing postoperative weight loss in dilated versus nondilated groups controlling for risk factors (age, gender, endoscopic dilation and preoperative BMI) found that age >45 (OR 1.76, 95%CI (1.28-2.40)) and preoperative BMI >median (53kg/m2) (OR 4.00, 95%CI (2.93-5.46)) were significant predictors of submedian %EBMIL; male gender (OR 1.29, 95%CI (0.85-1.94)) and endoscopic dilation (OR 0.95, 95%CI (0.44-2.03)) were not. CONCLUSION: After controlling for age, gender, and preoperative BMI, endoscopic balloon dilation to 15mm or higher does not impact postoperative weight loss at ≥1 year.