BACKGROUND Gastrojejunostomy (GJ) stricture is one of the most commonly recognized complications following laparoscopic Roux-en-Y gastric bypass (LRYGB). The risks involving the formation of early GJ stomal stenosis are largely unknown. The aims of this study are to evaluate the rate and risk factors associated with GJ stricture in patients requiring esophagogastroduodenoscopy (EGD) within 30 days after LRYGB. METHODS This is a retrospective study of patients who underwent EGD for GJ stricture following LRYGB. Data were retrieved from MBSAQIP database from 2015 to 2018. Descriptive, bivariate, and logistic regression analyses were performed. Those who had reoperation, readmission, and intervention for other indications rather than GJ stricture were excluded from the risk factor analysis. RESULTS 760,076 patients underwent bariatric surgery. Of these, 184,660 (24.3%) underwent LRYGB and 875 had GJ stricture within 30 days postoperatively. The overall incidence of early GJ stricture after LRYGB was 4.7 per 1000 person-years. The incidence decreased from 6.2 to 3.4 per 1000 person-years during the 4-year period. 85% of patients with GJ stricture required therapeutic intervention. Median (IQR) day to the first endoscopic intervention was 25 (21-28) days. The overall 30-day readmission rate was 40%. 30-day reoperation rate due to GJ stricture was 5.6%. No 30-day mortality occurred. Factors independently associated with an increased risk for early GJ stricture include concurrent hiatal hernia repair (Adjusted Odds Ratio-AOR 1.8, 95% CI 1.5-2.2), revision case (AOR 1.4, 95% CI 1.1-1.6), African American (AOR 1.4, 95% CI 1.2-1.7), gastroesophageal reflux disease-GERD (AOR 1.4, 95% CI 1.2-1.5), drain placement (AOR 1.3, 95% CI1.1-1.4), and routine postoperative swallow study (AOR 1.3, 95% CI 1.1-1.50). CONCLUSION The incidence of early GJ stricture following LRYGB decreased at MBSAQIP-accredited centers over the review period. Patients having additional manipulation at or around GJ were at risk of developing early GJ stricture after LRYGB.

中文翻译：

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腹腔镜 Roux-en-Y 胃旁路术后需要内镜干预的早期胃空肠吻合口狭窄的发生率和危险因素：MBSAQIP 分析。

背景 胃空肠吻合术 (GJ) 狭窄是腹腔镜 Roux-en-Y 胃旁路术 (LRYGB) 后最常见的并发症之一。涉及早期 GJ 造口狭窄形成的风险在很大程度上是未知的。本研究的目的是评估 LRYGB 术后 30 天内需要食管胃十二指肠镜检查 (EGD) 的患者的 GJ 狭窄发生率和相关风险因素。方法 这是一项对 LRYGB 后接受 EGD 治疗 GJ 狭窄的患者的回顾性研究。从 2015 年至 2018 年从 MBSAQIP 数据库中检索数据。进行了描述性、双变量和逻辑回归分析。因其他适应症而不是 GJ 狭窄而进行过再次手术、再入院和干预的患者被排除在危险因素分析之外。结果 760,076 名患者接受了减肥手术。其中，184,660 人 (24.3%) 接受了 LRYGB，875 人在术后 30 天内出现了 GJ 狭窄。LRYGB 后早期 GJ 狭窄的总体发生率为 4.7/1000 人年。在 4 年期间，发病率从每 1000 人年 6.2 例下降到 3.4 例。85% 的 GJ 狭窄患者需要治疗干预。第一次内窥镜干预的中位 (IQR) 天数为 25 (21-28) 天。总体 30 天再入院率为 40%。因 GJ 狭窄导致的 30 天再手术率为 5.6%。没有发生 30 天死亡率。与早期 GJ 狭窄风险增加独立相关的因素包括并发食管裂孔疝修补术（调整后的优势比-AOR 1.8，95% CI 1.5-2.2），翻修病例（AOR 1.4，95% CI 1.1-1.6），非裔美国人（AOR 1.4, 95% CI 1.2-1.7), 胃食管反流病-GERD (AOR 1.4, 95% CI 1.2-1. 5）、引流管放置（AOR 1.3，95% CI1.1-1.4）和常规术后吞咽研究（AOR 1.3，95% CI 1.1-1.50）。结论 在审查期间，在 MBSAQIP 认证的中心，LRYGB 后早期 GJ 狭窄的发生率有所下降。在 GJ 处或周围进行额外操作的患者在 LRYGB 后有发生早期 GJ 狭窄的风险。