Systematic review and meta-analysis
Endoscopic balloon dilation for treatment of sleeve gastrectomy stenosis: a systematic review and meta-analysis

https://doi.org/10.1016/j.gie.2019.11.034Get rights and content

Background and Aims

Gastric stenosis is a rare but potentially serious adverse event after sleeve gastrectomy. Despite current suboptimal treatments, endoscopic balloon dilatation (EBD) has emerged as a safe and efficacious approach. The purpose of this study is to assess the overall success of EBD for sleeve gastrectomy stenosis (SGS) as first-line therapy.

Methods

MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane Database were searched from inception to July 2018. The primary outcome was defined as overall success rate of clinical resolution of SGS obstructive symptoms with EBD, expressed as pooled event rate and 95% confidence interval (CI). The secondary predefined outcomes include EBD success rates for SGS in the proximal (cardia) location or mid-distal location (antrum/incisura), in early SGS (up to 3 months after laparoscopic sleeve gastrectomy), and late SGS (3 months or longer after laparoscopic sleeve gastrectomy) and success rate of cases requiring stents or salvage surgery.

Results

Eighteen studies encompassing 426 patients were analyzed. The average age and body mass index were 41.7 years and 40.1 kg/m2, respectively, and the average number of dilations for all cases was 1.8 per person. Overall EBD success rate was 76% (95% CI, .67-.86). EBD success rate in the proximal SGS was 90% (95% CI, 63%-98%), distal SGS was 70% (95% CI, 47%-86%), early SGS within 3 months was 59% (95% CI, 34%-79%), and late SGS after 3 months was 61% (95% CI, 41%-78%). Seventeen percent of patients underwent secondary salvage surgery, with a success rate of 91% (95% CI, 80%-96%).

Conclusions

Endoscopic balloon dilation appears to be a safe and effective minimally invasive alternative to surgical revision and should be used as first-line therapy for SGS

Abbreviations

CRE
controlled radial expansion
EBD
endoscopic balloon dilatation
LSG
laparoscopic sleeve gastrectomy
RYGB
Roux-en-Y gastric bypass
SEMS
self-expanding metal stent
SGS
sleeve gastrectomy stenosis

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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: C. C. Thompson: Consultant for and research support recipient from Boston Scientific and Olympus. All other authors disclosed no financial relationships relevant to this publication.

If you would like to chat with an author of this article, you may contact Dr Thompson at [email protected].

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