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DOI: 10.1055/a-1314-9094
Endoscopic approach to complex gastric tube stricture after laparoscopic sleeve gastroplasty: a case report
![](https://www.thieme-connect.de/media/endoscopy/202110/lookinside/thumbnails/2024_10-1055-a-1314-9094-1.jpg)
As bariatric surgery becomes more prevalent, endoscopists commonly face adverse events now that this minimally invasive treatment has little morbidity and great efficacy [1]. Gastric tube stricture is one of the most common adverse events, occurring in 0.1 to 3.9 % of patients [2] [3]. Mechanical stricture (gastric sleeve) and axis deviation are the entities that can cause obstruction [2].
Endoscopic treatment often includes pneumatic balloon dilation and/or self-expandable metal stent (SEMS) placement with great success rates [3] [4]. Recently, endoscopic tunneled stricturotomy has been adopted as a promising technique [5].
We present a case ([Video 1]) of a 55-year-old woman with morbid obesity (body mass index of 43.9 kg/m2). She underwent a laparoscopic sleeve gastrectomy and developed progressive dysphagia in the follow-up. Upper gastrointestinal (GI) endoscopy and contrast X-ray image revealed gastric tube stricture and axis deviation.
Video 1 Complex strictures after gastrointestinal surgery are challenging for endoscopic management. In this case report with video, we highlight different therapeutic endoscopic options that might be used in these cases.
Quality:
An endoscopic tunneled stricturotomy with full-thickness dissection was performed 6 months after the surgery, although without technical or clinical success.
A new endoscopic approach was performed with pneumatic balloon dilation (30 mm) followed by placement of a 23 × 105-mm partially covered esophageal SEMS (PCSEMS) ([Fig. 1]). To avoid stent migration, a nasoenteral feed tube with suture threads was fixed to the stent using metallic clips ([Fig. 2]). After this procedure, the patient improved clinically and tolerated a soft oral diet well.
![](https://www.thieme-connect.de/media/endoscopy/202110/thumbnails/10-1055-a-1314-9094-i2024ev1.jpg)
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![](https://www.thieme-connect.de/media/endoscopy/202110/thumbnails/10-1055-a-1314-9094-i2024ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
At 18 days after placement, intense tissue hyperplasia in the proximal and distal portions of the stent (uncovered areas) made removal impossible ([Fig. 3]). So a 23 × 155-mm fully covered esophageal stent (FCSEMS) was placed over the first stent (stent-in-stent technique) ([Fig. 4]). After 1 week, the patient presented good acceptance of a soft oral diet and both stents were removed endoscopically without complications ([Fig. 5]).
![](https://www.thieme-connect.de/media/endoscopy/202110/thumbnails/10-1055-a-1314-9094-i2024ev3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202110/thumbnails/10-1055-a-1314-9094-i2024ev4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202110/thumbnails/10-1055-a-1314-9094-i2024ev5.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Currently (2.5 months after the last procedure), the patient remains with a good soft oral diet intake and stable weight. She is satisfied with the improvement in her quality of life and no further endoscopic intervention is necessary.
Endoscopy_UCTN_Code_TTT_1AO_2AH
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Publication History
Article published online:
17 December 2020
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References
- 1 Deslauriers V, Beauchamp A, Garofalo F. et al. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis. Surgical Endoscopy 2018; 32: 601-609
- 2 Ogra R, Kini GP. Evolving endoscopic management options for symptomatic stenosis post-laparoscopic sleeve gastrectomy for morbid obesity: experience at a large bariatric surgery unit in New Zealand. Obesity Surgery 2015; 25: 242-248
- 3 Okazaki O, Bernardo WM, Brunaldi VO. et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obesity Surgery 2018; 28: 1788-1796
- 4 Agnihotri A, Barola S, Hill C. et al. An algorithmic approach to the management of gastric stenosis following laparoscopic sleeve gastrectomy. Obesity Surgery 2017; 27: 2628-2636
- 5 de Moura EGH, de Moura DTH, Sakai CM. et al. Endoscopic tunneled stricturotomy with full-thickness dissection in the management of a sleeve gastrectomy stenosis. Obesity Surgery 2019; 29: 2711-2712