Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos)


Autoria(s): CAMPOS, Josemberg Marins; EVANGELISTA, Luis Fernando; FERRAZ, Alvaro Antonio B.; GALVAO NETO, Manoel P.; MOURA, Eduardo Guimaraes H. De; SAKAI, Paulo; FERRAZ, Edmundo M.
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

19/10/2012

19/10/2012

2010

Resumo

Background: Silastic rings are used in gastric bypass procedures for the treatment of obesity, but ring slippage may lead to gastric pouch outlet stenosis (GPOS). Conventional management has been ring removal through abdominal surgery. Objective: To describe a novel, safe, minimally invasive, endoscopic technique for the treatment of GPOS caused by ring slippage after gastric bypass. Design: Case series. Setting: Federal University of Pernambuco and sao Paulo University. Patients: This study involved 39 consecutive patients who-were screened for inclusion. Intervention: Endoscopic dilation with an achalasia balloon. Main Outcome Measurements: Technical success and safety of the procedure. Results: Among the 39 patients, 35 underwent endoscopic dilation at the ring slippage site for the relief of GPOS. The 4 patients who did not undergo endoscopic dilation underwent surgical removal of the ring, based on the exclusion criteria. The endoscopic approach was successful in 1 to 4 sessions in 100% of cases with radioscopic control (n = 12). The duration of the procedures ranged from 5 to 30 minutes, and the average internment was 14.4 hours. Dilation promoted either rupture (65.7%) or stretching (34.3%) of the thread within the ring, thereby increasing the luminal diameter of the GPOS. Complications included self-limited upper digestive tract hemorrhage (n = 1) and asymptomatic ring erosion (n = 4). There were no recurrences of obstructive symptoms during the follow-up period (mean of 33.3 months). Limitations: This was not a randomized, comparison study, and the number of patients was relatively small. Conclusion: The technique described promotes the relief of GPOS with low overall morbidity and avoids abdominal reoperation for ring removal. (Gastrointest Endosc 2010;72:44-9.)

Identificador

GASTROINTESTINAL ENDOSCOPY, v.72, n.1, p.44-49, 2010

0016-5107

http://producao.usp.br/handle/BDPI/22085

10.1016/j.gie.2010.01.057

http://dx.doi.org/10.1016/j.gie.2010.01.057

Idioma(s)

eng

Publicador

MOSBY-ELSEVIER

Relação

Gastrointestinal Endoscopy

Direitos

restrictedAccess

Copyright MOSBY-ELSEVIER

Palavras-Chave #MANAGEMENT #Gastroenterology & Hepatology
Tipo

article

original article

publishedVersion