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Endoscopic Management of Post‑laparoscopic Re‑sleeve Gastrectomy
as a sharp angulation even though the scope passes into the antrum. therapy for stenosis of the mid-body of the gastric sleeve and is
Less frequently encountered is mechanical stenosis, presenting as likely the most common revisional operation performed in the
an anatomical obstruction. It can be found anywhere along the setting of sleeve stenosis. In some severe cases of stenosis, total
proximal gastric conduit and is usually described on endoscopy as gastrectomy may be necessary. 4
a mucosal narrowing. 4
In order to confirm the diagnosis of gastric sleeve stenosis, conclusIon
endoscopic and fluoroscopic investigations are essential. 6
Causes of stenosis may include reinforcement of the staple The earlier detection of post-sleeve gastrectomy stricture with
line with a running suture on a tight sleeve, aggressive or unequal effective management significantly reduces patient morbidity.
traction on the greater curvature during gastric stapling, or Endoscopic treatment with pneumatic balloon dilation and
insufficient posterior dissection of the posterior stomach off the stent insertion has repeatedly proven to be effective and safe
5
retroperitoneum. 4 as the first line of management for this complication as in our
On the contrary, complications of acute pancreatitis, such as case with two sites of stenosis and twisting because of severe
paralytic ileus, ischemic necrosis, perforation, and mechanical adhesions due to previous scar tissue and acute pancreatitis.
obstruction, are relatively infrequent. Mechanical bowel Surgical intervention should be considered only after the failure
obstruction as a result of acute pancreatitis has been described in of endoscopic treatment.
the literature and is more likely to occur in the splenic flexure and
transverse colon. This is believed to be due to severe inflammation rEfErEncEs
of the body and tail of the pancreas causing extrinsic compression 1. IFSO 2016 21st World Congress. Obes Surg 2016;26(Suppl. 1):1–691.
or due to retroperitoneal extravasation of pancreatic enzymes DOI: 10.1007/s11695-016-2287-9.
causing pericolitis and/or pericolic fibrosis. 7 2. Chang MA, Kwong W. Lumen-apposing metal stent for gastric
In case of revisional LSG like our patient, complete posterior stricture after sleeve gastrectomy. VideoGIE 2017;2(6):149–151. DOI:
dissection is usually more challenging, and together with 10.1016/j.vgie.2017.02.008.
developing acute pancreatitis with severe adhesions and previous 3. https://link.springer.com/chapter/10.1007/978-3-319-71282-6_3.
scar tissue, it may contribute to a higher stenosis rate. 6 4. The SAGES manual of Bariatric surgery. Springer Science and Business
Endoscopic intervention, including pneumatic dilation, and Media LLC; 2018.
endoscopic stent placement are first-line therapies for stenosis 5. https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-018-
0381-8.
discovered after the immediate perioperative period. Success rates 6. https://link.springer.com/article/10.1007%2Fs00464-017-5709-4.
for endoscopic therapy for sleeve stenosis have been reported as 7. Miln DC, Barclay TH. Acute colonic obstruction due to pancreatitis.
high as 88 to 94%. Conversion to RYGB is considered a definitive Lancet 1952;2(6726):168–169. DOI: 10.1016/S0140-6736(52)91696-6.

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